Saunders Natasha Ruth, Gandhi Sima, Wanigaratne Susitha, Lu Hong, Stukel Therese A, Glazier Richard H, Rayner Jennifer, Guttmann Astrid
The Hospital for Sick Children, Toronto, Canada.
Department of Pediatrics.
Pediatrics. 2023 Jan 1;151(1). doi: 10.1542/peds.2022-057441.
Resettled refugees land in Canada through 3 sponsorship models with similar health insurance and financial supports but differences in how resettlement is facilitated. We examined whether health system utilization, costs, and aggregate 1-year morbidity differed by resettlement model.
Population-based matched cohort study in Ontario, 2008 to 2018, including pediatric (0-17 years) resettled refugees and matched Ontario-born peers and categorized refugees by resettlement model: (1) private sponsorship (PSRs), (2) Blended Visa Office-Referred program (BVORs), and (3) government-assisted refugee (GAR). Primary outcomes were health system utilization and costs in year 1 in Canada. Multivariable logistic regression was used to test the associations between sponsorship model and major illnesses.
We included 23 287 resettled refugees (13 360 GARs, 1544 BVORs, 8383 PSRs) and 93 148 matched Ontario-born. Primary care visits were highest among GARs and lowest in PSRs (median visits [interquartile range], GARs 4[2-6]; BVORs 3[2-5]; PSRs 3[2-5]; P <.001). Emergency department visits and hospitalizations were more common among GARs and BVORs versus PSRs (emergency department: GARs 19.2%; BVORs 23.4%; PSRs 13.8%; hospitalizations: GARs 2.5%; BVORs 3.2%; PSRs 1.1%, P <.001). Mean 1-year health system costs were highest among GARs (mean [standard deviation] $1278 [$7475]) and lowest among PSRs ($555 [$2799]; Ontario-born $851 [9226]). Compared with PSRs, GARs (adjusted odds ratio 1.63, 95% confidence interval 1.47-1.81) and BVORs (adjusted odds ratio 1.52, 95% confidence interval 1.26-1.84) were more likely to have major illnesses.
Health care use and morbidity of PSRs suggests they are healthier and less costly than GARs and BVOR model refugees. Despite a greater intensity of health care utilization than Ontario-born, overall excess demand on the health system for all resettled refugee children is low.
重新安置的难民通过三种赞助模式抵达加拿大，这些模式提供类似的医疗保险和经济支持，但在安置便利程度上存在差异。我们研究了重新安置模式是否会导致医疗系统利用率、成本以及总体一年发病率的不同。
2008年至2018年在安大略省进行的基于人群的匹配队列研究，纳入重新安置的儿科（0至17岁）难民以及匹配的安大略省出生的同龄人，并按重新安置模式对难民进行分类：（1）私人赞助（PSR），（2）混合签证办公室推荐计划（BVOR），以及（3）政府协助难民（GAR）。主要结局是在加拿大第一年的医疗系统利用率和成本。使用多变量逻辑回归来检验赞助模式与重大疾病之间的关联。
我们纳入了23287名重新安置的难民（13360名GAR、1544名BVOR、8383名PSR）以及93148名匹配的安大略省出生的同龄人。初级保健就诊次数在GAR中最高，在PSR中最低（中位数就诊次数[四分位间距]，GAR为4[2 - 6]；BVOR为3[2 - 5]；PSR为3[2 - 5]；P <.001）。急诊科就诊和住院在GAR和BVOR中比在PSR中更常见（急诊科：GAR为19.2%；BVOR为23.4%；PSR为13.8%；住院：GAR为2.5%；BVOR为3.2%；PSR为1.1%，P <.001）。平均一年医疗系统成本在GAR中最高（均值[标准差]为1278美元[7475美元]），在PSR中最低（555美元[2799美元]；安大略省出生的人为851美元[9226美元]）。与PSR相比，GAR（调整后的优势比为1.63，95%置信区间为1.47 - 1.81）和BVOR（调整后的优势比为1.52，95%置信区间为1.26 - 1.84）患重大疾病的可能性更大。
PSR的医疗保健使用和发病率表明，他们比GAR和BVOR模式的难民更健康且成本更低。尽管重新安置的难民儿童的医疗保健利用率高于安大略省出生的儿童，但所有重新安置的难民儿童对医疗系统的总体额外需求较低。
