How to improve the health and access to care of uninsured migrants in Montreal?

health and access to care for immigrants in montreal

Starting in 2013, researchers from different universities and backgrounds and Doctors of the World Canada, committed to a participatory process for developing the protocol of an intervention research on migrants without health insurance. The first phase of the research allowed for an understanding of the intervention by Doctors of the World, an assessment of available knowledge and the identification of research objectives. For details see the research notes and posters.

Canada has very few studies specifically focusing on access to healthcare by people without medical insurance. Most previous studies aim to assess the level of access to healthcare by migrant pregnant women without medical insurance or study a specific group of migrants such as asylum seekers.

Since 2011, immigration policies in Canada have become increasingly restrictive. Consequently, it has become harder to obtain permanent resident status and access Medicare (RAMQ). The number of migrants with temporary, incomplete and/or expensive health insurance has risen exponentially. However, there is no statistical data available to verify the situation observed in the field. It is also noteworthy that a lot of migrants with precarious status are uninsured for long periods of time. Once again, this information has not been documented. This means that in case of illness, these future Canadians have to pay for their care and often pay fees that are higher than those paid by Canadian residents. On the other hand, for some, it becomes impossible to have access to healthcare whilst ill or seriously ill. In Montreal, the Doctors of the World clinic is the only place where people without health insurance can have access to free healthcare. This clinic is able to provide care for a specific health problem only. Doctors of the World is unable to offer all the services needed due to limited resources.

The following objectives have been formulated in collaboration with Doctors of the World and representatives from community organizations.

  1. To study the health status and access to care of uninsured migrants.
  2. To understand the development, implementation and sustainability of health initiatives for this population throughout Canada, in order to create strategies applicable in the Montreal context.
  3. To understand the viewpoints and decisions of stakeholders at all decision-making levels within the health system.
  4. To generate results that are widely applicable, as well as to contribute to social change and development of policies that may in turn favor improving the population’s access to healthcare.

Our study includes: all migrants with no public or private health insurance. People without a RAMQ card, the Interim Federal Health Program (IFHP) for asylum seekers, or private health insurance at the time of the study. Participants should be over 18 years old, live or have the intention of living in Quebec for at least 6 months. Those excluded from the study are permanent residents who do not have healthcare due to their RAMQ card having been stolen or lost. Those who await the receipt of the RAMQ card, i.e. within in the three months delay, are also not included in this study.

About migrants

A quantitative survey will be carried out on uninsured migrants. It will be focused mainly on access to care, health, work and living conditions. The participants will be partly recruited at the Doctors of the World clinic (Total=500) while others will be selected from within the community (Total=400). The questionnaire will be prepared in French, English, Spanish, Haitian Creole, Mandarin.

Qualitative interviews will be conducted with 30 participants who have experienced illness whilst lacking health insurance to find out about their life trajectory and access to health services during this period.   The interviews will include those who easily accessed care, as well as others who did not access healthcare services so as to compare both groups’ life and health trajectories.

About health initiatives

Qualitative interviews will be carried out with people working on health initiatives (including health and social work professionals, administrators, etc) in Montreal (Total=20), Toronto (Total=8) and Vancouver (Total=8). We will try to understand how the initiatives were developed, their goals and the way through which have they have become sustainable (or not).

About policymakers

Qualitative interviews will be conducted with 20 policymakers and administrators working as part of Quebec’s professional associations and the public health system. We are going to analyze the decisions and recommendations made regarding uninsured migrants as well as the factors that influenced them. We will also analyze their knowledge of this complex problem.

For an overview of the project, read the summary section at the top.

Principal researcher: Dr. Valéry Ridde
Professor at the School of Public Health, University of Montreal (ESPUM).
Researcher at the Public Health Research Institute, University of Montreal (IRSPUM)

 

Co-researchers:

  • Josephine Aho,  Epidemiologist, Director of Public Health Montreal.
  • Patrick Cloos, Associate Professor at the School of Social Work, University of Montreal.
  • Jill Hanley, Associate Professor at the School of Social Work, McGill University.
  • Elhadji Mbaye, Postdoctoral Researcher at the Institute Beauvoir, Concordia University.
  • Maria Muñoz-Bertrand, Doctor, Director of Public Health Montreal, Clinical Lecturer at the Department of Family Medicine and Emergency Medicine, University of Montreal.
  • Marie-Jo Ouimet,  Doctor, Director of Public Health Montreal, Clinical Lecturer at the Department of Social and Preventive Medicine (DMSP) at the School of Public Health, University of Montreal (ESPUM).
  • Marie France Raynault, Medical Advisor, Director of Public Health of Montreal, Professor at the School of Public Health, University of Montreal (ESPUM).

Students:

  • Jessika Huard
    Master’s student in public health, global health option, in the School of Public Health of the University of Montreal (ESPUM). Her traineeship is on the development of recruitment strategies in community organizations and places of worship. Her interests are: Reproductive health, HIV in developing countries, access to care for vulnerable populations, immigrants’ health and social inequalities in health.
  • Ke Zhou
    Master’s student in public health at the School of Higher Studies in Public Health (EHESP) from Rennes, France. His traineeship is on the development and implementation of recruitment strategies in hard-to-reach communities. He is particularly interested in socio-ecological interventions, integrating elements of epidemiologic and economic evaluation.
  • Solène Lagrange
    Trainee with the research coordinator. She is a pharmacist by training and holds a Master’s degree in public health from the Institute of Public Health, Epidemiology and Development of Bordeaux, France. She is particularly interested in issues of access to health care and population health, and the links between public health policies and societal issues. She chose to associate her medical knowledge with the management, evaluation, organization of health care and the health welfare of the populations.
  • Veronica Torres
    Master’s Degree in Public Health, Global Health Option at the School of Public Health of Université de Montréal. She is a specialist in ENT with several years of professional practice in the public and private sectors. She works on health initiatives for precarious migrants in Montreal, Toronto and Vancouver. She mainly focuses on vulnerable populations, universal access to care and social inequalities in health.
  • Ekta Kumar
    Trainee in social work at McGill University. She is concerned with the protection of human rights and universal access to health services. In addition, she wants to better understand the issues facing migrants. She focuses on raising awareness among South Asian clients and building relationships with community organizations in Montreal.

Research Coordinator:
Magalie Benoit, Msc, Public Health Research Institute of the University of Montreal (IRSPUM)

 

Publications

Benoit, M., Belaid, L., & Ridde, V. (2013). Projet Migrants : la logique de l’intervention de Médecins du Monde (MdM) à Montréal. Download
Benoit, M., Ridde, V., Belaid, L., & Houle, V. (2013). Une cartographie conceptuelle des défis de l’action de Médecins du Monde en faveur des migrants à statut précaire à Montréal. Download
Belaid, L., Ridde, V., & Benoit, M. (2013). Pourquoi est-ce si difficile de soigner les migrants à statut précaire à Montréal ? Download
Ridde, V. (2017, June). The health and access to care of uninsured migrants in Montreal. Presented at the M8 Alliance Expert Meeting on Migrants’ and Refugees’ Health, Sapienza University of Rome. Retrieved from https://www.slideshare.net/valery_ridde/the-health-and-access-to-care-of-uninsured-migrants-in-montreal Download
Boudreault, P. (2017, March). Migrants with precarious status: challenges accessing health and social services. Presented at the 19th National Metropolis Conference, Montréal. Retrieved from https://fr.slideshare.net/valery_ridde/migrants-with-precarious-status-challenges-accessing-health-and-social-services Download
Hanley, J., & Benoit, M. (2017, March). Understanding the health status of uninsured migrants in Montreal: towards improving access to care. Presented at the 19th National Metropolis Conference, Montreal. Retrieved from https://fr.slideshare.net/valery_ridde/understanding-the-health-status-of-uninsured-migrants-in-montreal-towards-improving-access-to-care Download
Munoz, M. (2017, March). Research on uninsured migrants: a focus on women’s health. Presented at the Sixth annual conference of McGill’s Comparative Health Systems Program, Montréal. Retrieved from https://fr.slideshare.net/valery_ridde/research-on-uninsured-migrants-a-focus-on-womens-health Download
Cloos, P., Munoz, M., & Houde, O. (2016, November). Les migrants non-assurés face au système de santé: portrait de l’exclusion. Résultats préliminaires d’une étude transversale, Montréal. Presented at the Colloque “Accueillir les réfugiés: pratiques et politiques”, organisé par Sherpa, Montréal. Retrieved from http://www.equitesante.org/migrants-non-assures-face-systeme-de-sante-portrait-de-lexclusion/
Valéry Ridde, M. B. (2014, May). Réflexions sur la participation dans l’élaboration d’un projet de recherche sur l’accès aux soins pour les migrants à statut précaire à Montréal. Retrieved from http://fr.slideshare.net/valery_ridde/prsentation-acfas-34580346
Benoit, M., Belaid, L., Ridde, V., & Houle, V. (2013). Les défis engendrés par la limite des ressources du projet de Médecins du (MDM) en faveur des migrants à statut précaire à Montréal. Retrieved from http://fr.slideshare.net/valery_ridde/les-dfis-engendrs-par-la-limite-des-ressources-du-projet-de-mdecins-du-mdm-en-faveur-des-migrants-statut-prcaire-montral
Ridde, V., & Benoit, M. (2013). Résultats préliminaires d’une recherche action sur les défis de l’intervention de Médecins du Monde à Montréal. Retrieved from http://fr.slideshare.net/valery_ridde/prsentation-comit-de-soins-md-m
Benoit, M., & Ridde, V. (2013). Planification du projet de recherche sur les migrants à statut précaire à Montréal. Retrieved from http://fr.slideshare.net/valery_ridde/suite-de-la-planification-du-projet-de-recherche-sur-les-migrants-statut-prcaire-montral
Zhou, K. (2016). Development of participant recruitment strategy in the project “How to improve health and access to health care of migrants without medical coverage in Montreal” - the case of the Chinese community. (Master of Public Health). Ecole des hautes études en santé publique (EHESP), France., Institut de Recherche en Santé Publique de l’Université de Montréal (IRSPUM), Montréal, Canada. Download
Huard, J. (2016). Les stratégies de recrutement des migrants sans assurance médicale dans un contexte de recherche à Montréal : Comment contrer la méfiance des participants? (Rapport de stage). Montréal, Canada: Département de Médecine Sociale et Préventive, École de Santé Publique de l’Université de Montréal (ESPUM). Download
Médecins du Monde. (2015). Rapport d’activités 2014-2015 (p. 24). Montréal, Canada. Download
Benoit, M. (2014). Planification d’un projet de recherche sur l’accès aux soins des migrants à statut précaire à Montréal : enjeux contextuels, participatifs et méthodologiques (Rapport de stage). Montréal: l’École de santé publique. Download
Ridde, V., & Benoit, M. (2016, February). Résumé du projet de recherche - Comment améliorer la santé et l’accès aux soins des migrants sans assurance médicale (MSAM) à Montréal? Download
Butoyi, J., Ridde, V., & Ogunnaike-Cooke, S. (2015, May). Leçons apprises : évaluations et méthodes pour enquêter auprès des populations difficiles à joindre. Poster presented at the Congrès national 2015 de la Société canadienne d’évaluation (SCÉ). Download
Valéry Ridde, M. B. (2014, May). Réflexions sur la participation dans l’élaboration d’un projet de recherche sur l’accès aux soins pour les migrants à statut précaire à Montréal. Retrieved from http://fr.slideshare.net/valery_ridde/prsentation-acfas-34580346
Benoit, M., Houle, V., Belaid, L., & Ridde, V. (2013). Planification d’une recherche interventionnelle sur l’accès aux soins des migrants à statut précaire à Montréal. Retrieved from http://fr.slideshare.net/valery_ridde/planification-dune-recherche-magalie-benoit-1-vronique-houle-2-interventionnelle-sur-laccs-aux-soins-des-migrants-statut-prcaire-montral

Access the Community Resource Guide in the Montreal area (click on the image below):

  • Medical Clinic of Médecins du Monde

To make an appointment, please leave a message on the voicemail  –  Phone : 514-609-4197 Download brochure

  • Legal advice

The fair solutions Clinic offers free legal advice to refugees and migrants with precarious status. To make an appointment with them, call 514-844-9128 ext. 201 or email moc.l1574153198iamg@1574153198setsu1574153198j.sno1574153198itulo1574153198s1574153198
You can also Visit the website here.

  • Help and support

Solidarity without Borders offers self-help groups for migrants every month. They have various committees for access to housing, education, food, health care and status for all. To join them, call 438-933-7654 or email:  moc.l1574153198iamg@1574153198serei1574153198tnorf1574153198snase1574153198tirad1574153198ilos1574153198
You can also Visit the website here.

  • The Survival Guide
Guide de survie - Ressources et conseils pour les personnes sans statut à Montréal. (2012). Solidarité Sans Frontières, Médecins du Monde Canada, Solutions Justes, le Centre des Travailleurs et Travailleuses Immigrants, AGIR. Download
  • Immigration
    •  Preparation for the hearing on the asylum application (available in French, English, Spanish, Farsi, Chinese, Arabic).
      Download guide here (pdf)
    • Right of border crossing for refugees. A multilingual guide (available in Arabic, Amharic, Chinese, Spanish, Farsi, Filipino, French, Haitian Creole, Kurdish (Sorani), Punjabi, Somali, Tamil, Tigrinya, Twi, Urdu, Vietnamese): Download guide (pdf)
  • Health Care

Information on medical clinics for sexual and reproductive health:
Quebec Federation for Birth Planning

 

Partners

Logo Médecins du Monde

Doctors of the World Canada is the main organization involved in this research as well as in the work to promote access to healthcare for migrants without medical insurance in Montreal. Since autumn 2011 this organization offers 6 monthly medical clinics. Services are offered by volunteer health professionals (doctors, nurses, social workers, etc.). They also offer services to pregnant women. They have established an advocacy group, where researches are present to reflect on the uses of the research. This group’s main concern pertains to various problems concerning access to care (confidentiality, access to care for pregnant women, or children born to parents without legal status in Canada, public health issues and overbilling). For more information about local interventions by Doctors of the World you may review the Activity Report 2014 – 2015.

Logo CRCHUM

Since its inception, the Director of Public Health to the CIUSSS Centre-Sud-de-l’île-de-Montreal has been involved in the project. The pilot project was funded by the CIUSSS and several of the researchers involved are affiliated to the CIUSSS. In this way, the CIUSSS lends its expertise to the research and intends to utilize the knowledge generated.