Access without Care: Health Care Access Experiences of Privately Sponsored Refugees In Canada

Background and Purpose: The private sponsorship model is a critical element of the Canadian refugee resettlement program. While prior research focuses on resettlement and integration outcomes, less is known about how privately sponsored refugees navigate access to health care after arrival. Refugees face significant health and mental health inequities, shaped by structural and post-migration determinants such as healthcare access, housing instability, and social exclusion. Access to sustained, culturally responsive care remains uneven. Formal health coverage is often assumed to lead to care; however, refugees' experiences suggest that formal coverage does not guarantee meaningful access to care. This study addresses this gap by examining how access to health and mental health is produced, mediated, and constrained within Canadian privately sponsored refugee resettlement. The study asks: How do refugees, sponsors, and service providers experience and navigate health systems, and what structural factors shape access to care? Results from refugee interviews are presented here.

Methods: This study employs a qualitative case study design using 31 in-depth, semi-structured interviews with privately sponsored refugees. Interviews were conducted in-person and remotely, with approximately two-thirds facilitated through professional interpreters and one-third conducted in English. Participants were recruited through targeted outreach to refugee settlement, sponsorship, health, and community-based organizations, followed by snowball sampling across seven provinces and one territory in Canada. Interviews were transcribed and analyzed using Sort and Sift, Think and Shift in combination with thematic analysis.

Results: Our findings reveal that formal eligibility for services does not translate into sustained or effective healthcare. Participants described fragmented and conditional access shaped by limited availability of primary care providers, long wait times, and reliance on walk-in clinics, resulting in episodic and discontinuous care. Cost and coverage gaps as well as financial barriers to accessing medications, diagnostics, and specialized services led medication rationing, delayed treatment, and transnational care-seeking. Access to care was relationally mediated, with outcomes shaped by sponsorship quality, informal support networks, and language access. Limited interpretation services and system navigation challenges constrained access, particularly for mental health care. Thus, structural and systemic barriers significantly shaped refugee health outcomes.

Conclusions and Implications: Our findings challenge assumptions about universal healthcare accessibility by demonstrating how structural conditions produce unequal access to care among refugees. Health access emerges as a socially mediated and structurally contingent process rather than a function of formal eligibility alone. At the policy level, the study provides evidence to support reforms addressing coverage gaps in medications and mental health services across sponsorship pathways, with implications for improving equitable access within publicly funded healthcare systems. Our findings have also informed advocacy efforts opposing the co-payment changes to the Interim Federal Health Program, which comes into effect on May 1, 2026, and will see refugees having to pay co-payments for medications and supplemental services. Implications also include the need for integrated, trauma-informed, and culturally responsive care models, expanded interpretation and navigation support, and policy reforms addressing coverage gaps and inequities. By foregrounding how systems shape access, this study informs equitable health policy and practice for displaced populations.