Newcomer Children Use Emergency Departments Less for Minor Illness Than Ontario-Born Peers

The assumption that newcomers strain emergency departments by using them for routine care does not match what the data show in Ontario. A large population-based study from ICES and The Hospital for Sick Children, published in JAMA Network Open, tracked nearly half a million children over the first four years after arrival in Canada and found the opposite pattern: refugee and immigrant children were less likely, not more likely, to visit emergency departments for non-urgent conditions compared to children born in Ontario.

What the data covered

The study followed 458,597 children total: 113,098 who arrived as refugees or immigrants, compared against 345,499 Ontario-born children during the same period. Researchers examined minor illness visits - conditions like respiratory infections that could reasonably be handled in primary care settings - and tracked where those visits occurred: emergency department or primary care.

In the first two years after arrival, refugee and immigrant children who had at least one minor illness visit were less likely to seek emergency care for those conditions and more likely to see a primary care provider. Ontario-born children, who have grown up within the system and are presumably most familiar with it, showed the inverse pattern: they were the most likely group to use emergency departments for non-urgent problems and the least likely to use primary care for similar conditions.

The settlement services effect

One of the more specific findings points toward a mechanism. Resettled refugees - those who arrive through government-assisted or privately sponsored programs - have access to settlement workers during their first year in Canada who help with healthcare navigation alongside other resettlement tasks. The reduction in non-urgent emergency visits was stronger in this group than among other immigrant categories.

"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," said Dr. Astrid Guttmann, co-director of the Edwin S.H. Leong Centre for Healthy Children at SickKids and senior scientist at ICES.

This is a plausible interpretation but carries the usual caveats of observational research. The study cannot randomly assign children to receive or not receive settlement services, which means unmeasured differences between resettled refugees and other immigrant groups could explain part of the pattern. Even so, the specificity of the effect - stronger where support is more intensive - is consistent with the proposed mechanism.

What happens after two years

The picture shifts somewhat after the two-year mark. Among resettled refugee children, primary care visits for minor conditions declined while non-urgent emergency visits increased. The researchers suggest this may reflect a practical constraint: reduced financial settlement support after the initial resettlement period coincides with challenges accessing primary care during regular working hours. Emergency departments are open around the clock without an appointment - a convenience that becomes more relevant when a caregiver is working inflexible hours and cannot easily schedule a daytime primary care visit.

This trajectory suggests that the benefits of settlement support in healthcare navigation may be tied to its duration. Policies that extend or modify support to address healthcare access beyond the first year could potentially sustain the early-arrival pattern of more appropriate care-seeking.

Limitations and context

The study explicitly notes that it did not account for parental employment status or education level, both of which are known to influence healthcare-seeking behavior. These are genuine gaps in the analysis, not trivial ones - a parent working night shifts faces different barriers to primary care access than one with flexible daytime hours, and this variation likely explains some of what the data show as a group-level trend.

The research contributes to a growing body of evidence from comparable high-income countries suggesting that inclusive healthcare for migrants does not impose extraordinary costs on health systems. The study's co-author Dr. Susitha Wanigaratne noted that some international evidence suggests inclusive care for migrants actually reduces costs by preventing complications from delayed treatment - a framing that reorients the policy conversation from burden toward investment.