ORIGINAL PAPER Emergency Room Visits by Uninsured Child and Adult Residents in Ontario, Canada: What Diagnoses, Severity and Visit Disposition Reveal About the Impact of Being Uninsured Michaela Hynie 1 • Chris I. Ardern 2 • Angela Robertson 3 Ó Springer Science+Business Media New York 2016 Abstract Canadian immigrants can be without health insurance for many reasons but limited data exists regarding uninsured health outcomes. Uninsured Canadian residents were identified in the National Ambulatory Care Reporting System for all visits to emergency departments in Ontario, Canada between 2002/3 and 2010/11 (N = 44,489,750). Frequencies for main diagnoses, severity (triage), and visit disposition were compared. Ambulatory care sensitive conditions were identified in a 10 % subsample. The uninsured (N = 140,730; 0.32 %) were more likely to be diagnosed with mental health (in- sured: 3.48 %; uninsured: 10.47 %) or obstetric problems (insured: 2.69 %; uninsured: 5.56 %), be triaged into the two most severe categories (insured: 11.2 %; uninsured 15.6 %), leave untreated (insured: 3.1 %; uninsured: 5.4 %), or die (insured: 2.8 %; uninsured: 3.7 %). More ACSC visits were made by uninsured children and youth. Insurance status is associated with more serious health status on arrival to emergency departments and more negative visit outcomes. Keywords Healthcare access Á Emergency department Á Health equity Á Social determinants Á Immigration Background Despite Canada’s universal health care system, there are a number of Canadian residents who do not have health care coverage. However, although it is recognized that a lack of health insurance has individual and public health conse- quences, there are limited data available about the number of people in Canada who are affected and their health outcomes [1, 2]. Most residents in Canada are insured by provincial insurance plans, which vary in terms of coverage and eligibility for coverage, although some residents (e.g., government sponsored refugees, military personnel) have federal health insurance. Because there is a universal health care system, in the Canadian context lack of insurance is tied to migration. Prior to 2012, there were a variety of ways in which individuals in Ontario became uninsured. In three pro- vinces, including Ontario, new permanent residents, or those who have been living outside of the province, wait three months before they have access to health insurance [3]. Other pathways are violations of temporary work permits; immigration sponsorship breakdown; overstaying visitor or work visas; or being a visitor, foreign student or belonging to certain categories of temporary worker [4, 5]. There are also those who are entitled to health insurance but lack documentation. For example, people who are homeless and/or lack secure housing can face challenges in safely storing their documents, and without these docu- ments are often treated as if they were uninsured [6]. A growing body of qualitative research with Canadian residents with precarious migration status suggests that & Michaela Hynie mhynie@yorku.ca Chris I. Ardern cardern@yorku.ca Angela Robertson robertson@ctchc.com 1 Department of Psychology, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada 2 School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada 3 Queen West–Central Toronto Community Health Centre, 68 Bathurst Street, Toronto, ON M5V 2R4, Canada 123 J Immigrant Minority Health DOI 10.1007/s10903-016-0351-0