Refugee healthcare in Canada
The Canadian Centre for Refugee & Immigrant Health Care published a series of patient stories in the Spring of 2017 illustrating the impact and state of health services for refugees in Canada. One is the story of Samir, who arrived to Canada with his mother at the age of twelve and was denied access to health insurance for 90 days, a period during which he broke his arm from falling off of his bike. The Emergency Department in Toronto refused to see him unless his mother paid a $500 fee, of which she was unable to pay. Another is the story of Nadia, age two, who has lived in Toronto since she was two months old. She does not have the Ontario Health Insurance Plan (OHIP), and all healthcare costs must be paid for out of pocket.
The Interim Federal Health Program (IFHP) was most recently in the news in August 2017, when Asylum seekers crossing the border into Quebec were accessing health services through the program prior to the government knowing whether they were eligible to make the refugee claim. Through IFHP, more than 5,600 asylum-seekers have accessed services prior to being deemed eligible for refugee status.
International human rights norms have been interpreted to encompass a right to timely and appropriate care, which requires governments to refrain from denying or limiting access to asylum-seekers and illegal immigrants. Despite Canada’s Interim Federal Health Program, for some populations in the country, access to care may be a fundamental human rights issue faced regularly.
Cuts to the Interim Federal Health Program “Cruel and Unusual Treatment”
The Interim Federal Health Program is a temporary health insurance program for refugees, protected persons, and refugee claimants in Canada. In June of 2012, the federal government implemented changes to the program resulting in the effective elimination of health care coverage for many refugees and refugee claimants. The changes involved the differentiation of refugees by category for determining levels of coverage. Health care access was limited for all refugee claimants, especially for claimants from certain countries who were eligible for almost none. Changes included no longer covering necessary medications and denying access to physicians unless the condition was a threat to public safety. Prenatal care, child care and access to mental health were also cut for some refugees. Some provinces, including Ontario and Quebec, offered their own programs in order to make up for the gap in services. The rationale was that it would generate savings that totalled over $20 million annually and that it would discourage unfounded refugee claims. However, health-care providers pointed towards how this may increase use of emergency rooms and hospitals which will only increase costs to the system.
The Wellesley Institute conducted an analysis of the changes and reported that the cuts to health benefits in the program were having several negative health outcomes for refugees and claimants. To illustrate, there was the story of two young children with multiple hospitalizations for asthma who could not access to inhalers and the story of a teenager with PTSD who was cut off from accessing necessary psychiatric medications. The Institute reported that refugees and claimants were faced with the choice of deciding to either forego medical treatment, use emergency departments or incur significant medical bills they are unable to play. The changes resulted in confusion and administrative complexity for health providers.
The change was fought by health providers and advocacy groups. In June 2012, demonstrations were held in 14 cities across Canada with over 2000 health providers present. Dr. Parisa Rezaiefar, a family physician and refugee in Ottawa, was quoted in the media for urging Minister Kenney to not take away from refugees as the “interim Federal Health Program is not a charity; it is an investment in the future of the country”.
The policy was eventually appealed to the Federal Court in Ottawa by refugee and medical advocacy groups who were able to demonstrated 40 cases in which denial of medical insurance created hardship. Justice Mactavish described the health-care cuts a form of “cruel and unusual treatment” and ruled them unconstitutional under section 12 of the Canadian Charter of Rights and Freedoms. The policy was found to have intentionally targeted vulnerable children and adults.
The Re-instated Interim Federal Health Program
April 1, 2016, the federal government, now Liberal, re-instated the IFHP. The coverage is very similar to that for individuals on social assistance. Today the IFHP provides “limited, temporary coverage of health-care benefits to people in the following groups who aren’t eligible for provincial or territorial health insurance: Protected persons, including resettled refugees; Refugee claimants; Certain other groups.” Basic coverage includes in-patient and out-patient hospital services, services from medical doctors, RNs and other health-care professionals licensed in Canada, including pre- and post-natal care, and laboratory, diagnostic and ambulance services. The supplemental coverage has limited vision and urgent dental care, home care and long-term care, and services from allied health professionals, as well as some assistive devices and medical supplies and equipment.
With the influx of Syrian refugees to Canada, a number of health clinics and services for immigrants and refugees specifically were implemented. However, despite the changes to IFHP, Y.Y. Brandon Chen and Vanessa Gruben, members of the University of Ottawa’s Faculty of Common Law, have suggested that despite the policy changes, many refugees continue to be left without adequate access to health services. The IFHP still invokes confusion, and because of the previous cuts, many health providers and walk-in clinics will not see or provide services to refugees out of concern they will not be reimbursed. Health service providers have complained about the complexity of the system. After being registered, service providers have trouble deciphering what services are covered and after providing them, waiting weeks or months to be reimbursed. Furthermore, many people crossing the border and claiming refugee status will be denied a valid refugee claim, some may choose to stay in Canada illegally without health-care insurance. It has been suggested that this will actually cost the health system more. For example, pregnant women crossing the border who do not get insured are problematic for the health system as babies born too early and too small cost the system a great deal. But more importantly, there will be more babies born unhealthy. As refugee care is an integral part of our health system, these are issues that need to be addressed in order for the program to have success.