Opinion

In Support of Refugee Medical Care

The Federal Government's plan to reduce medical services available to refugee claimants in Canada is a false economy that will be unfair to refugees and risky for public health.

By Tim O'Shea
Published June 07, 2012

On June 30 of this year, the federal government will implement a plan to severely reduce the medical services available to refugees and refugee claimants in Canada. These changes will create a group of legal residents of Canada who will have no access to health care, even in instances of threat to life or limb.

The Canadian health care community, including a vocal contingent in Hamilton, has responded with great deal of concern and has called for a national day of action on June 18.

The current Interim Federal Health (IFH) program provides funding for comprehensive health care service for refugees while they await adjudication of their claims.

This program includes coverage for physician services, diagnostics and certain prescription medications, which in Ontario equates roughly to the funding available for low income and senior citizens. The estimated yearly cost of this program is $83 million.

The proposed changes to the IFH program would see all "supplemental benefits" eliminated, including prescription medication coverage. In addition for refugee claimants from as yet unidentified "designated countries of origin," all coverage will be removed with the exception of services provided for diseases and conditions which pose a risk to public health or safety.

The federal government estimates that this will save approximately $20 million per year over a five-year period.

Serious Issues with Government Claims

In proposing these changes, the Harper government has suggested at least four potential benefits: cost savings, enhanced public health and safety, a reduction in "bogus refugee claims", and fairness to Canadian taxpayers who do not have access to enhanced services such as prescription medication coverage.

Serious issues exist with each of these arguments.

1) With respect to cost, there is a large body of evidence that has shown conclusively that decreasing access to primary care increases costs in the long run.

This policy will ensure that diabetics do not have access to insulin, that epileptic children will not be able to afford anti-seizure medication and that fewer refugee claimants will be able to access a family physician. The result will be increased hospitalizations and an overall increase in costs.

2) Diseases of public health concern are frequently thought of as those that can be passed from person to person, such as, for example, tuberculosis. Again, evidence in this area is clear that these types of conditions are best diagnosed in primary care settings.

Under the current plan, refugees who do not have access to a family physician will be far more likely to ignore their persistent cough until their illness progresses to the degree that a hospital visit is required. These delays in diagnosis and treatment will result in a poorer prognosis for the patient as well as an increase in the number of individuals exposed to these potentially preventable conditions.

3) Much of the impetus for the proposed changes seems to be based on a belief that a significant proportion of refugee claimants in Canada are "bogus" and are at least in part motivated by a desire to take advantage of free health care. However, the evidence to back this claim is lacking, and the fact that refugee claimants utilize the health care system at a rate that is only one-tenth the rate of the general population suggest that it is simply untrue.

To put the issue in perspective, at the end of 2010 Canada hosted approximately 150,000 refugees, comprising about 1% of the global refugee population. Most western democracies, including the United States, provide refugees with health care coverage similar to what is offered under the current IFH plan, making Canada no more attractive based on health care coverage than several other countries.

The fact of the matter is that the vast majority of refugees come to Canada fleeing situations of intense persecution, often as the victims of severe physical and psychological trauma. The notion that they are here to game the system for free health care appears far-fetched at best.

Regardless, if the government truly desires to cut down on fraudulent refugee claims, there must be more humane and just ways of doing so than denying an entire group access to potentially life saving health care.

4) The final claim of benefit put forth by the Harper government is in many ways the toughest to swallow. Federal Immigration Minister Jason Kenney has stated repeatedly that the changes he has proposed will impart a level of fairness to the system. He is determined, he says, to see that refugees do not enjoy more generous health care benefits than hard working Canadians.

First of all, his claim is simply not true. Almost all refugees in Canada would qualify, were they citizens, for social support programs such as Ontario Works, which would provide them with the supplemental coverage that is being targeted by these changes.

Secondly his comments fail to take into account the context of most refugee claims. I work at a health care clinic for new arrivers to Canada. The patients that I see frequently have suffered immense physical and psychological trauma, the likes of which most Canadians thankfully could not imagine. They often arrive in Canada with little more than the clothes on their backs. In many cases they do not speak English.

To suggest that they are in a similar position to afford these medications as a self-employed Canadian is simply disingenuous.

Widespread Opposition

On May 16, a group of Hamilton physicians made a presentation to the general affairs committee of Hamilton City Council in support of a motion brought by Councilor Brian McHattie. The motion expressed concern over the potential negative consequences of the proposed changes to IFH for the City of Hamilton and its residents, and called on the federal government to forgo their planned cuts. The motion was adopted unanimously.

Similar letters of concern have been submitted by several medical organizations, including the Canadian Medical Association, the Royal College of Physicians and Surgeons, the Canadian Dental Association, the Registered Nurses' Association of Ontario, and the Canadian Association of Midwives.

Thus far, the government has shown no indication that they are inclined to change their minds. If this continues to be the case, my patient described above will not have access to the medications she requires to keep her safe and healthy. Some refugees will not be able to receive care for life-threatening illnesses.

The government of Canada has framed these changes as being fair and balanced. From my point of view they appear to be anything but.

For more information on the national day of action, visit www.doctorsforrefugeecare.ca.

Tim O'Shea, MD, FRCPC, MPH, is an assistant professor, Assistant Professor in the Department of Medicine, Division of Infectious Diseases at McMaster University.

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By BeulahAve (registered) | Posted June 07, 2012 at 13:08:23

This is a very important issue for a vulnerable segment of our population, and I thank you for sharing your concerns more widely. And for getting the word out about the national day of action.

The Harper government knows who its supporters are, and it has been successful at capitalizing on concerns for cost-saving measures (the F-35 fighter plane issue notwithstanding -- what irony!), especially when it comes to those are marginalized, not political active, and -- most notably -- not Canadian. If anything can convince this government to change its mind, it will be making some kind of business case for care now costing less than care later, as you have done. However, with the changes to refugee law coming into effect, the government is counting on many refugee claimants not being successful, and therefore not bearing those long-term costs at all because the claimants will no longer be in Canada.

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By Undustrial (registered) - website | Posted June 08, 2012 at 00:29:32

Imagine for a moment that Canada has been torn apart by civil war or environmental cataclysm, and that you've been forced to flee with nothing but the clothes on your back and what's left of your family. After months in a series of refugee camps, you finally make it to a peaceful and prosperous country. Once there, you find yourself treated like a suspect for the very act of trying to survive. How would you feel?

This is a low blow, even for Harper.

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By Son of refugees (anonymous) | Posted June 11, 2012 at 16:52:11 in reply to Comment 78158

My family was in a country that had free healthcare. They left the country as refugees, despote the access to healthcare. They were happy to escape the threat of violence and arrive in a country where you can work hard and make it. Health care wasn't why they came here. People come here to escape violence and to make a decent life. Not a single one of them feels victimized for not getting free things. The idea that they feel like victims for having access to *almost* everything other Canadians have access to is just nuts. Refugees don't feel like victims within Canada, and they largely understand that they must earn their keep and integrate into society before benefitting from it's perks.

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By chris angel (registered) | Posted June 11, 2012 at 14:22:03

Mr. O'Shea, unfortunately a significant percentage of the general public is convinced that the issue of "bogus refugee claimants" is larger; perhaps much larger than it really is. There have been examples of a number of false refugee claimant sub categories paraded across TV screens and vilified in other media. These include claimants of "convenience" who hold nothing but contempt for western society and who are ready and highly likely to repatriate when it suits them. There have been criminals and human rights abusers masquerading as refugees. However; I cannot recall ever having seen dragged through the public square, an example of a false refugee claimant here to exploit the Canadian medical system. That makes no sense at all as so much is in the hands of each province. In Ontario we have OHIP not CANHIP. Any refugee who has managed to decipher the intricacies of Canadian medical services and learned which provincial system is best exploited is truly a genius and should be hot listed for citizenship.

I do not doubt that what we are dealing with is miniscule but the statement "With respect to cost, there is a large body of evidence that has shown conclusively that decreasing access to primary care increases costs in the long run." needs to be supported. I am convinced; but many people I encounter would not be. They are cynical I am afraid and many seem to feel that blanket statements claiming overwhelming evidence while citing not a shred frequently have no evidence at all. Without citing a few examples I don't think any minds will be changed and that would be a shame.

The supplemental coverage currently provided to refugee claimants IS better than the coverage too many Canadians have. I know far, far too many people who exist or who have had to exist on one or more part time jobs. These jobs and many full time entry level positions have ZERO supplemental coverage. A cold which slowly escalates into a more serious throat or bronchial issue could easily require an $80 puffer and a $65 antibiotic leaving a person struggling for survival with a bill they can only beg to have paid. That any person should experience a situation like that in our society is a travesty. Where is the outpouring of support for those people? We all know that supplemental is not supplemental anymore. Drug and dental are not supplemental they are essential. The absence of either is life shortening and can easily be life threatening. Too many employers use every resource possible to avoid having to provide supplemental benefits by using self employment schemes or staffing with part time workers then expanding hours to 40+ hrs / week without reclassifying as full time etc., etc. There is a scoop in the income slope where the working poor reside. Which takes more than 20% in income taxes and gives nothing back in the form of "supplemental" supports. Pray you do not end up there and if you are able; fight so that others don't. If there were not a significant number of such people the national conservatives would not be attempting to pit one against the other with statements about levelling the playing field. Minister Kenney should remember next time that taking something away from one group so that both groups now have nothing is called cold comfort. Employing a classic "class envy" tactic only works by redistribution not by depriving all parties. The website doctorsforrefugeecare comes off looking a little self serving like a group of doctors fighting to preserve the current system because they care and oh incidentally their jobs are dependant upon it too. Broadening that role to be totally inclusive of so-called supplemental benefits to everyone would go a long way towards eliminating that aspect.

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By its all about the money (anonymous) | Posted June 11, 2012 at 17:47:30

once again a few have spoiled it for the many. With so many of the refugees coming from the parts of the world that are leaders in terrorism it is no wonder that the average joe has little or no sympathy for them. Over the years as more and more incidents have happened against the west my attitude has changed a great deal and so have many others.

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By TimO'Shea (anonymous) | Posted June 13, 2012 at 08:52:29

Chris and "son of refugees"

Thanks for your thoughtful comments. To clarify I agree completely that by and large the refugee population that I deal with in my medical practice do not feel like victims and they are indeed quite grateful for the opportunity that they have been given. As well I agree that many Canadians struggle with the cost of prescription medications and that a national strategy must be developed to deal with this serious issue which has enormous implications for our system which claims equitable access to health care for all. However there are a few points that I would like to reiterate; first access to the highest attainable standard of health is a human right enshrined in international covenants to which Canada is a party. Under this new policy there will be legal residents of Canada who have absolutely no health care coverage even if their life is at risk. Second, the issue of cost is particularly relevant for this population; I have a patient whose monthly medication bill is ~350 dollars, all for medications necessary to prevent serious complications. She receives ~ 650 dollars per month to support her and her three children, and has no means to supplement this income. If she were a citizen of this country she would be able to both apply for work to supplement her income, and she would qualify for Ontario Works which would cover her medication and allow her to not have to choose between her health and food/rent for her and her children. The fact that there are Canadians who have difficulty affording their medications (which I agree is unjust) does not make the situation of my patient any less unjust. That is what we are arguing against on June 18th. I hope you join us.

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By Ryan (registered) - website | Posted June 29, 2012 at 13:13:08

CBC Hamilton has a report on this story, including quotes from Dr. Tim O'Shea.

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