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Research on uninsured migrants: a focus on women's health

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This presentation was designed by Marie Munoz for the sixth annual conference of McGill’s Comparative Health Systems Program. The conference held on March 11th, 2017 was based on the theme of Women's Health.

Publié dans : Santé & Médecine
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Research on uninsured migrants: a focus on women's health

  1. 1. Research on uninsured migrants: a focus on women’s health Dr Marie Munoz-Bertrand MD MSc CIUSSS Centre-Sud de Montréal Médecins du Monde Université de Montréal
  2. 2. 2
  3. 3. Retrospective chart review of prenatal care and perinatal outcomes Design: • Retrospective cohort study • 71 uninsured women/72 control subjects Key findings: • Difficult to identify uninsured migrants from charts • Uninsured women • presented later for care • had fewer visits with heath care providers • had fewer prenatal tests • We were not able to document perinatal adverse outcomes Jarvis, 2011
  4. 4. Scoping review on undocumented pregnant women • 23 articles met inclusion criteria (10 US, 2 Canada, 11 Europe) • 71-5961 women enrolled • Undocumented migrants • Younger, unmarried, working in the domestic sector • Less access to prenatal care • Inadequate prenatal care • Adverse outcomes in 3/6 studies (Low birth weight, prematurity, Pre eclampsia, bleeding,..) • Other findings: unintentional pregnancies, low contraception use, exposure to intimate partner violence Munro, 2012
  5. 5. Irregular migrants in Canada • Lack of data • Canada: 100 000 to 500 000 persons
  6. 6. Montreal • 20 000 to 50 000 precarious status migrants • Most of migrants with precarious status are not irregular • No public services designed for this population • Negative impact on access to health care and health reported, sub standard care by health providers Brabant 2012, Ter Kuile 2007, Rousseau 2008
  7. 7. Uninsured migrants • Migrants in irregular situation but also • Regular migration • 3 months waiting period • Student visa • Persons between two status • Dependents of migrant with working or study visa
  8. 8. Médecins du Monde • had experience offering health care to excluded populations • had become sensitized to the situation of uninsured migrants ØAttempt to find a public structure interested in this population ØEvaluation process led to the implementation of a project for migrants
  9. 9. Migrant project - Objectives • Provide care • Allow access to health care for uninsured migrants • Help clarify and regularize status if possible • Work towards a solution • Document situation of uninsured migrants in Montreal • Advocate to find solutions to health care access issues
  10. 10. 184 1409 670 2729 3290 184 665 865 795 0 500 1000 1500 2000 2500 3000 3500 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 Uninsured migrants having received services at MDM Total Persons seen at the clinic
  11. 11. Médecins du Monde 2015-2016
  12. 12. Médecins du Monde 2015-2016
  13. 13. Huard, 2016
  14. 14. Huard, 2016
  15. 15. Huard, 2016
  16. 16. https://www.facebook.com/Sant%C3%A9-des-Migrants- 1758295444410771/
  17. 17. Preliminary results (February 2017)
  18. 18. Status according to gender Femmes Hommes Réfugié accepté 0,3 0,0 Demandeur du statut de réfugié ou demandeur d’asile refusé (avant date de renvoi) 9,2 11,4 Travailleur étranger temporaire ou dépendants 3,8 3,4 Étudiant ou dépendants 7,3 5,1 Visiteur (long-terme, Super Visa, PVT, etc.) 25,5 17,0 Autre permis de résidence temporaire (ex: en attente de parrainage) 14,0 10,2 Aucun (application en cours) 18,2 16,5 Aucun (aucune application en cours) 15,6 27,3 Résident permanent 2,9 3,4 Citoyen canadien 0,6 1,7 Ne sait pas 1,3 1,7 Ne souhaite pas répondre 1,3 2,3 33,8 43,8
  19. 19. Marital status 49.5 7.7 6.7 7.3 5.1 23.6 42.9 6.2 2.3 4.5 6.2 37.9 0 10 20 30 40 50 60 Marié(e) Union libre/conjoint de fait Veuf/ veuve Séparé(e) Divorcé(e) Célibataire % Femme % Homme
  20. 20. Income 0 10 20 30 40 50 60 income no income studying other no answer % Femme % Homme
  21. 21. 0 10 20 30 40 50 60 70 80 90 Pas assez d’argent pour payer les frais Craignait une facture trop élevée Ne savait pas où aller Problème de langue Peur déportation/ impact sur statut refus de l'hôpital/clinique % Raison Raison pour laquelle les soins n'ont pas été obtenus % Femme % Homme
  22. 22. Pregnancy (preliminary results) • 67% women in childbearing age • 42% had at least one pregnancy while uninsured • Mean age at pregnancy: 29 75% 18% 7% Number of pregnancies while unisured 1 2 3
  23. 23. Pregnancy follow up 22% 35% 22% 12% 0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 1 VISIT 2-5 VISITS 6-9 VISITS >10 VISITS number of prenatal visits 73, 71% 30, 29% Pregnancy follow up pregnancy follow-up no pregnancy follow up 0 5 10 15 20 25 1 2 3 4 5 6 7 8 9 Timing of initiation of pregnancy follow up
  24. 24. Pregnancy (preliminary results) • Place of delivery: 93% gave birth in a hospital • Fees • Mean 8 000$ • Range: 1 100 to 41 500$
  25. 25. Access to immunization: a survey at MDM • Convenience sample of 88 facilities • 31 CLSC • 55 clinics • 2 private clinics • Questionnaire administered • to intake clerk or nurse • by 11 volunteers
  26. 26. Type of facility n Vaccination provision Maximal fees Insured children Uninsured children Clinics that charge fees Per vaccine Per visit CLSC 31 26 18 5 205$ 35$ GMF 29 9 4 3 10$ 200$ walk in clinics 26 8 3 20$ 140$ private clinics 2 1 1 100-200$ 80$ the total cost of complete immunisation of a child from 2 months to 4 years old can range from $130 to $2 676.18
  27. 27. Immunization study Objectives: • Describe the demographic profile of uninsured women and children in Quebec • Promote immunization in this population • Influence public policy Design: • Action research • Population: women in child-bearing age (15-49yo) and children 0-17 in Quebec for less than 5 years
  28. 28. Acknowledgements • Marie-Jo Ouimet • Catherine Jarvis • Vinita d’Souza • Lisa Graves • Zoé Brabant • Véronique Houle • Nadja Pollaert • Chloé Cembron • Katharina Bourgin • Pénélope Boudreault • Maude Blanchette-Lamothe • Laurence Ethier • Sarah Simmons • Louis-Thomas Moisan • Sophie Giguère • Sarika Beauchamp • Marianne Leaune-Welt • Valéry Ridde • Magalie Benoit • Amandine Fillol • Jessika Huard • Joséphine Aho • Patrick Cloos • Jill Hanley • Marie-France Raynault • Ke Zhou • Solène Lagrange • Veronica Torres • Ekta Kumar • all surveyors and participants of the study
  29. 29. Thank you Questions? Comments? Suggestions?
  30. 30. References • Caulford, P. et Vali, Y. Providing health care to medically uninsured immigrants and refugees. Canadian Medical Association Journal. 2006 Apr 25; 174(9): 1253-1254. • Rousseau C, Ter Kuile S, Munoz M, Nadeau L, Ouimet, MJ , Kirmayer L, Crépeau F. Health care access for refugee and immigrant with precarious status: public health and human right challenges. Canadian Journal of Public Heath. Vol 99, no 4, july/august 2008 • Munro K, Jarvis C, Munoz M, D’Souza V, Graves L. Undocumented Pregnant Women: What Does the Litterature Tell Us? J Immigrant Minority Health. J Immigr Minor Health. 2012 Mar 1 • Jarvis, C, Munoz, M, Graves, L, D’Souza, V, Jimenez, V. A Retrospective Review of Prenatal Care and Perinatal Outcomes in a Group of Uninsured Pregnant Women. JOGC. March 2011. • Brabant, Z. et Raynault, M.-F. Health situation of migrants with precarious status: results of an exploratory study in Montreal – Part B. Social Work in Public Health. 2012, 27: 469-481. • Brabant, Z. et Raynault, M.-F. Health situation of migrants with precarious status: review of the literature and implications for the Canadian context – Part A. Social Work in Public Health. 2012, 27: 330-344. • http://www.equitesante.org/projet-migrants/
  31. 31. • https://www.youtube.com/watch?v=Zc0gdY022_M&t=82s

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