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Study finds resettled refugee children and youth do not place significant demands on the Canadian healthcare system


Though refugee children and youth who arrive in Canada have differing healthcare needs, a new study from researchers at The Hospital for Sick Children (SickKids) and ICES finds that the overall excess demand on the health system is minimal and healthcare utilization varies by sponsorship model.

The study, published in Pediatrics, examines healthcare use and costs of paediatric refugees by resettlement model in the first year after refugees land in Ontario. The findings show more major illness and healthcare utilization in refugees who are government-assisted and arrive through the Blended-Visa Office Program compared to privately sponsored refugee children and youth.

In recent years, Canada has opened its doors to refugees fleeing violence and persecution and welcomed tens of thousands of children and their caregiver(s) each year. Ontario alone receives approximately 50 per cent of Canada’s refugees, and 98 per cent settle in urban areas.

Two of Canada’s resettlement streams involve private citizens who are fully or partially responsible for early support to refugees. The Private Sponsorship of Refugees (PSRs) program tasks private sponsors with raising funds to support the refugees in the first year and provide assistance with health and social services navigation. A Blended Visa Office-Referred Program (BVORs) model shares costs and resettlement activities between the private sponsor and the Government of Canada.

The Government Assisted Refugees (GARs) program provides all funding, support, and linkages to refugee resettlement services, mainly through service provider organizations. Refugees in all three models are eligible for provincial health insurance upon arrival.

“We don’t know enough about how the private and blended models meet the healthcare needs of resettled refugees, compared to the government assisted refugee program,” says lead author Dr. Natasha Saunders, staff physician and associate scientist in the Child Health Evaluative Sciences program at SickKids and adjunct scientist at ICES. “Many refugee children and youth arrive in Canada needing healthcare support, often for issues related to infection, malnutrition, or dental needs, and private sponsorship models may have an impact on how refugees navigate and access health services.”

Comparing 23,287 resettled refugees (13,360 GARs, 1544 BVORs, 8,383 PSRs) to 93,148 matched Ontario-born children and youth from 2008 to 2018, the researchers found that:

  • Primary care utilization was high across all refugee groups, with the highest observed for GARs. Mean one-year health costs were highest among GARs and lowest among PSRs.
  • PSRs used emergency care services less than other resettled refugees and Ontario-born peers, while BVORs’ use of emergency care was highest.
  • Among refugees, privately sponsored refugees had the lowest reported rates of major illnesses after one year and used fewer healthcare resources.

Overall, at the current levels of Canadian resettlement, refugee children and youth do not place substantial demands on the healthcare system compared to their Ontario-born peers, even in the first year of resettlement.

Notably, mental health services use was low for all refugee groups, especially for PSRs. Some children may be accessing mental health support through community resources, but this could also signal an unmet need that requires additional research.

“While our study is reassuring in terms of the high levels of primary care use in the first year, refugee groups with high health needs may benefit from specialized and integrated community-based primary care, such as that provided by community health centres and refugee health clinics to address health and social service needs to ensure a positive health trajectory for all resettled refugee children”  says senior author Dr. Astrid Guttmann, chief science officer at ICES (on academic leave), staff physician and senior scientist in the Child Health Evaluative Sciences program at SickKids.

The study, “Healthcare use and system costs among paediatric refugees to Canada” was published in Pediatrics.

Author block: Saunders NR, Gandhi S, Wanigaratne S, Lu H, Stukel TA, Glazier R, Rayner J, Guttmann A.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario

The Hospital for Sick Children (SickKids)
is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is a founding member of Kids Health Alliance, a network of partners working to create a high quality, consistent and coordinated approach to paediatric healthcare that is centred around children, youth and their families. SickKids is proud of its vision for “Healthier Children. A Better World.”


Misty Pratt
Senior Communications Officer, ICES
[email protected]


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