In Canada, health care is paid for by taxpayers, but it doesn't reduce expensive emergency room visits by people with disabilities - a key argument the Obama administration claimed in passing the Affordable Care Act.

But it's a small study published in the journal Canadian Family Physician - the larger study is being done in the U.S., where Obamacare premiums are going up another 18-23 percent. None of the savings have been realized yet, nor are insurers making more money from premiums. Instead, people who had insurance kept it if they could, and now pay higher premiums so that people who didn't want insurance could get it in case they need it 20 years from now.

The study, conducted at a Family Health Team in Kitchener-Waterloo, Ont., compared 40 high-needs patients at the team's mobility clinic for people with disabilities with 80 people from the team's general patient population.

Patients with disabilities were more likely to use emergency departments than patients without disabilities, even when they had access to primary health care, suggesting they still had unmet medical needs, said study author Dr. Aisha Lofters, a family physician with the St. Michael's Hospital Academic Family Health Team in Toronto. This runs counter to much previous research that attributed higher Emergency Department use among vulnerable populations to lack of access to primary care.

Dr. Lofters said that while the sample size was small, some important findings were detected that merit further investigation.

• Half of clinic patients with disabilities had visited the emergency room at least once in the preceding year despite having access to primary care, compared to about 30 per cent of clinic patients without disabilities.

• Patients from the mobility clinic were twice as likely to report an annual household income of less than $40,000 and were more likely to report their health status as fair or poor.
• Patients with disabilities were also more than twice as likely to be on financial benefits or social assistance than patients from the general population.
• Surveyed mobility clinic visitors were mostly senior males, and often experienced additional health issues relating to their physical impairment.

"As our general population ages, it's important to recognize that this large group of people may start experiencing socioeconomic disparities and physical ailments, and it's our responsibility to make sure they don't fall through the cracks of our current health care system," Dr. Lofters said.