Recent public uproar in response to federal government cutbacks to the Interim Federal Health Program (IFHP) should come as no surprise. The program, which provides limited health care benefits to people not eligible for provincial or territorial health insurance (i.e. refugees and non-citizens), was cut back on June 30, 2012. Critics from within the health professional have declared the refugee health care cuts inhumane.
Changes to the IFHP came soon after the introduction of Bill C-31, “Protecting Canada’s Immigration System Act”, which was implemented on February 14, 2012. The Bill divided refugees into four categories: protected persons; refugee claimants from non-designated countries of origin (DCOs); ejected refugee claimants; and refugee claimants from DCO’s – effectively discriminating based on point of arrival.
Prior to this, all refugee claimants automatically received extended health coverage from Canada’s federal government; since 1975, that coverage had been paid for by Citizenship and Immigration Canada.
A Health Equity Impact Assessment on the IFHP completed by the Wellesley Institute just prior to the aforementioned cutbacks observed that the proposed changes would have a negative impact on overall refugee health. It went on to note that changes to the IFHP would cause an increase in both emergency room visits and the prevalence of chronic conditions in refugee populations. Given the perceived negative impact of these changes, many have asked why the federal government did not focus instead on improving the delivery of health services to what is an already vulnerable population.
The answer to that question lies in a government focused on efficiencies and in many ways built around a promise to eliminate the federal deficit. Total spending on health care in Canada reached an astonishing $208 billion in 2012, and governments of all sizes are increasingly focused on controlling health care costs — as achieved, for example, through cutbacks to programs such as the IFHP. But these cost-cutting measures can have disproportionate effects on disadvantaged populations. Whether the federal government based Bill C-31 and IHFP cutbacks solely on efficiency in the health care system, or whether it was directly targeting specific groups, is unclear. What is certain is that a message at the core of the Canadian health care system, to “embrace diversity and nurture empowering relationships”, has been reduced to mere words on a page.
The medical community, including the Canadian Medical Association, the Royal College of Physicians, and the Registered Nurse Association of Ontario (RNAO) have brought forward considerable opposition to the IHFP cutbacks since 2012. Yet the opinions of front-line professionals in the field seems to have had little impact on a federal government focused on getting more “bang for its buck.”
The RNAO in particular was quick to speak out against the cutbacks, issuing an action alert that demanded a swift reversal. In response, Ontario’s provincial government introduced the Ontario Temporary Health Program (OTHP) on January 1st, 2014 to address the existing gaps in health coverage for refugee claimants. These gaps have led to confusion surrounding patient entitlements and the means for paying for necessary medication, as well as the loss of psychological support for refugees who may be survivors of rape, torture, and other forms of organized violence. Access to primary care and supplemental benefits for refugee claimants has been significantly reduced. The OTHP will attempt to offer a provincial response to a federally-created problem.
Recent cutbacks to the IFHP and the introduction of Bill C-31 were introduced by the federal government as cost-saving measures. But while these changes may indeed bring some level of positive economic impact, they are also likely to result in an increase in spending on health care services as refugees are diverted away from primary care preventive settings to emergency rooms and inpatient hospitalizations.
Overall, these changes work to further victimize an already vulnerable population. For many refugees, the resettlement process will become even more stressful than it is now, as a lack of access to health care services will negatively impact both physical and mental health. The federal government has made it increasingly difficult for refugees to integrate themselves into Canadian communities. It should instead be focused on delivering evidence-based and equitable health care to all people living in Canada, irrespective of immigration status or country of origin.
Haleema Butt is a 2016 Master of Public Policy candidate at the School of Public Policy and Governance, University of Toronto. She graduated with a Bachelor in Health Studies from York University, specializing in Health Management. Her policy interests include health policy, social and economic policy, and community sustainability.