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.
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.
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.