(PART 1) It Costs us all more to deny healthcare

May 7th, 2012

The following letter has been sent to all Toronto City Councillors in advance of Today’s vote to affirm ( or not ) what the Toronto Board of Health meeting historically accomplished on April 29th 2013 for the uninsured. One of the fully endorsed recommendations was the provision of healthcare for Canada’s uninsured living in Toronto.

Well done Mr Mihevc and Dr McKeown!

Board of Health – Meeting 21
HL21.5 Medically Uninsured Residents in Toronto  (Ward All)
Dear City Council members
On May 7th 2013 you are scheduled to consider
Board of Health – Meeting 21
HL21.5 Medically Uninsured Residents in Toronto  (Ward All)
One consideration you will contemplate are the financial implications of providing access to care for medically uninsured refugee claimants immigrants in the Toronto. The prevailing “myth” is that providing this care is more expensive than withholding it.
The available evidence has proven that the exact opposite is the case. The provision of frontline healthcare to this medically uninsured population saves money – and a lot of it. The same evidence from research studies clearly underscores the benefits and savings to the system in terms of system throughput, ER wait times and staffing, bed availability, overcrowding, and lengths of stay on expensive hospitals.
The facts are as follows
1) One study in a city with high numbers of uninsured immigrants describes the NET after costs outcomes when 13,000 uninsured were provided with free access to comprehensive 24/7 Primary Care health services.
– $ 2,000,000 annually in savings at the local hospital by prevented admissions and ER visits
– more bed availability and shorter stays for all patients admitted to hospital
– $700,000 in improved revenue for the hospital because of more bed availability for insured patients who were denied admission pre project.
reference: Academic Medicine 2000, 75 (4): 323 – 330., Managed care for Uninsured Patients at an Academic Health Centre., Arthur Kauffman, et al.
2)  20 % of the patients we treat at the Community Volunteer Clinic for medically uninsured newcomers to Canada are pregnant. The majority ( a total of 250) have received no, or inadequate pregnancy care. Having no care results in a 7 times increase in maternal band newborn morbidity and mortality. The cost of providing basic antenatal pregnancy care ( not including delivery) to one expectant immigrant mother is ( based on fee for service. In a midwife clinic it is considerable less)
3)  the cost to provide the social, educational and healthcare costs to one damaged newborn ( asphyxia at birth, advanced prematurity, neonatal and infant sepsis) is $500,000-1,000,000 dollars. This is based on an educational study conducted in New York State.
It is not  health wise or economically sound fiscal policy to put a mother and Canadian pregnancy at risk, as often happens in unattended pregnancies. At our Community Volunteer Clinic in Scarborough we routinely see pregnant women denied access to pregnancy, and delivery care. Their only option is to go the ER in labour – a most cost ineffective step. They end up in labour and delivery, without a full medical history and end up with an urgent C- Section – again an dangerous and high cost delivery.
The time has come for someone in the political landscape to come to their senses and take what is ethically, morally, and economically — the right step.


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