title: Uninsured immigrant and refugee children presenting to Canadian paediatric emergency departments: Disparities in help-seeking and service delivery.
abstract: BACKGROUND
  Access to health care for medically uninsured immigrant and refugee children is a public health concern due to the consequences of delayed or substandard care for child development and health.
  
  
  OBJECTIVE
  To explore possible differences in help-seeking and service delivery across migratory statuses, institutions and provinces.
  
  
  METHODS
  A review was undertaken of 2035 emergency files of immigrant, refugee and undocumented children without provincial health care coverage who sought care at three major paediatric hospitals in Montreal (Quebec) and Toronto (Ontario) during 2008 and 2009.
  
  
  RESULTS
  Refugee claimant children with Interim Federal Health Program benefits consulted for less urgent problems than the overall hospital population, except in one hospital that had a multicultural paediatric ambulatory clinic. Undocumented children and new permanent resident immigrant children within the three-month waiting period for provincial health care coverage were over-represented in the very urgent triage category and presented more often for injuries, trauma and mental health problems than did refugee claimant children.
  
  
  CONCLUSIONS
  Wide interhospital differences suggest that the predicament of limited access to health care of these groups of vulnerable medically uninsured children needs to be addressed through further research to inform policies and develop training.
authors.affiliation: McGill University, L'Équipe de recherche et d'intervention transculturelles, Centre de santé et de services sociaux de la Montagne, Montreal, Quebec;
authors.forename: Cécile
authors.initials: C
authors.lastname: Rousseau
authors.affiliation: McGill University, L'Équipe de recherche et d'intervention transculturelles, Centre de santé et de services sociaux de la Montagne, Montreal, Quebec;
authors.forename: Audrey
authors.initials: A
authors.lastname: Laurin-Lamothe
authors.affiliation: The Hospital for Sick Children, Learning Institute & Research Institute, Psychiatry, University of Toronto, Toronto, Ontario;
authors.forename: Joanna Anneke
authors.initials: JA
authors.lastname: Rummens
authors.affiliation: McGill University, L'Équipe de recherche et d'intervention transculturelles, Centre de santé et de services sociaux de la Montagne, Montreal, Quebec;
authors.forename: Francesca
authors.initials: F
authors.lastname: Meloni
authors.affiliation: McGill University, Department of Public Health;
authors.forename: Nicolas
authors.initials: N
authors.lastname: Steinmetz
authors.affiliation: Montreal University, Centre hospitalier universitaire Ste-Justine, Montreal, Quebec.
authors.forename: Fernando
authors.initials: F
authors.lastname: Alvarez
keywords: Emergency; Migration; Paediatric; Refugee