UC-ON
UC-ON is a multi-site data collaborative focused on clinics that serve uninsured and undocumented patients across Ontario. The goal is pretty simple: right now, these clinics are doing critical work, but the data is fragmented and often not usable across sites. We’re building a standardized, de-identified dataset so we can describe service use patterns, patient needs, barriers to access, and resource intensity — and ultimately support better planning and stronger funding advocacy with real evidence.
Background
Ontario’s healthcare system is frequently characterized as universal; however, a substantial and poorly measured population remains excluded from consistent access to publicly funded care. Existing literature suggests that between 200,000 and 500,000 people in Ontario alone are medically uninsured at any given time, largely due to immigration-related barriers, including undocumented status, expired or precarious immigration status, temporary resident categories, and mandatory waiting periods for provincial coverage such as the Ontario Health Insurance Plan (OHIP) (Garasia et al., 2023).
The gaps within this space are not theoretical. For example, the OHIP three-month waiting period (which was temporarily lifted during the COVID-19 pandemic) historically left many newcomers without coverage during their initial settlement period, contributing to delayed or forgone care (Niraula et al., 2023). Contrary to being often described as universal, this dynamic creates a de facto uninsured population that relies on a patchwork of services, including community health centres (CHCs), dedicated uninsured walk-in clinics, volunteer-run clinics, and informal referral networks (Health Network for Uninsured Clients, n.d.).
Despite the critical role these clinics play, there is a striking lack of Canadian, Ontario-specific quantitative literature that systematically describes who these patients are, what care they receive, the barriers they face, and the resources required to meet demand. A recent systematic review of evidence on uninsured migrant populations in Canada identified only 10 quantitative studies, and importantly, no quantitative research capturing economic costs associated with uninsured care (Garasia et al., 2023). Existing work is often qualitative, geographically limited, or aggregated in ways that obscure operational realities at the clinic level. Even foundational estimates of the uninsured population are broad and imprecise, reflecting substantial measurement challenges rather than definitive counts (Garasia et al., 2023).
The absence of robust data is resulting in concrete consequences where both patients and the Canadian healthcare system are suffering. Clinics serving uninsured and undocumented populations frequently operate with limited resources, variable funding streams, and chronic demand-capacity mismatches, yet they lack the empirical evidence needed to justify staffing models, service structures, or stable funding. Clinics, funders and policymakers, in turn, lack data that quantifies unmet need, service utilization patterns, and resource intensity, making it difficult to design targeted investments, system-level supports, or efficient workflow maps that could improve access and outcomes (Health Network for Uninsured Clients, n.d.).
This project aims to respond directly to the gap in the literature through the creation of a multi-clinic, standardized, de-identified dataset drawn from clinics already providing care to uninsured and undocumented patients across the GTA and Ontario. By leveraging existing partnerships and routinely collected clinical data, this project will generate actionable evidence that supports:
- More efficient and equitable resource allocation within clinics
- Stronger funding and policy advocacy grounded in real service utilization data
- A foundational empirical literature base for uninsured care in Ontario
Project team
- Ayyah Elayan
- Rukana Ragutharan
TRP supervisors
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