Refugee and immigrant children less likely to use emergency departments for minor illnesses

Refugee and immigrant children are less likely to visit the emergency department (ED) for minor illnesses (e.g., respiratory infections) compared to children born in Ontario, according to a new study from ICES and The Hospital for Sick Children (SickKids). 

The study followed 458,597 children (113,098 refugee and immigrant children for the first four years after arrival to Canada and 345,499 Ontarian-born within the same period). The researchers found that refugee and immigrant children had more primary care visits for minor illnesses and fewer non-urgent ED visits for similar conditions than their Ontario-born peers. One possible explanation for fewer ED visits for minor illnesses among resettled refugee families in particular, may be related to the healthcare-navigation support that these families receive during early settlement. However, after two years of arrival, primary care visits for minor conditions decreased while non-urgent ED visits increased among all resettled refugee children, which the authors suggest may be related to reduced resettlement financial support and the challenge these families may face accessing primary care during regular work hours. 

"This study contributes to the growing research that disproves the belief that newcomers misuse healthcare services," says Dr. Susitha Wanigaratne, Senior Research Associate at the Edwin S.H. Leong Centre for Healthy Children and SickKids, a fellow at ICES, and an adjunct lecturer at the Dalla Lana School of Public Health. "In addition, some studies from comparable, high-income countries suggest that inclusive health care for migrants not only improves health outcomes but also reduces costs." 

Key findings 

• Refugee and immigrant children who had at least one minor illness visit were less likely to visit the ED for non-urgent health problems in the first two years of arrival and more likely to have primary care visits for similar problems than children born in Ontario. 

• While resettled refugees were more likely to be affiliated with a community health centre than other immigrant groups, this did not help explain their more appropriate use of the healthcare system. 

• Ontario-born children who would typically be more familiar with the healthcare system were the most likely to visit the ED for non-urgent health problems and the least likely to have primary care visits for similar problems. 

"In Canada, government‑assisted and privately sponsored refugees have access to settlement workers and sponsors during their first year in the country," says Dr. Astrid Guttmann, Co-Director of the Edwin S.H. Leong Centre for Healthy Children, and a senior scientist at ICES and SickKids. "While all refugee children had lower numbers of ED visits for minor problems, the effect was stronger in resettled refugee children, suggesting settlement services have a positive effect on healthcare navigation." 

One limitation of the study is that it did not account for factors, including parental employment and education level, that may influence a caregiver's decision to use the ED for non‑urgent conditions.