Filling the Gaps

Why providing health care to refugees makes sense for Alberta

October 2013

Filling the Gaps

Why providing health care to refugees makes sense for Alberta
The federal government has recently changed the way it provides health care for refugees and refugee claimants. In June 2012 they made significant cuts to the Interim Federal Health Program (IFHP), the program that provides compensation for medical care to refugees and refugee claimants.1,2 The new rules left many without coverage, even in the case of life-threatening medical illnesses like a heart attack or cancer. 3 Even some pregnant women and children have been denied access to doctors visits, prenatal care, and essential medicines. This new system has created gaps that threaten the health and wellbeing of all Albertans. There is growing evidence that the changes to the IFHP may actually end up costing more money than it promised to save, leaving provinces with the bill. 4 Refugees and refugee claimants may be avoiding medical care until they are extremely unwell, turning easily treated conditions into expensive hospital stays and emergency room visits. This puts an additional strain on our already overburdened health care system and may expose the public to undiagnosed infectious illnesses. Manitoba and Quebec have recognized these risks and are now filling in the gaps left by the cuts to the IFHP. 5,6

Alberta should follow their example and step up to cover the medical needs of refugees and refugee claimants.

Refugee health cuts hurt all Albertans

Frontline healthcare workers, public health experts, and medical organizations have all expressed significant concerns about the cuts to the IFHP. 7-9 We have already started to suffer the consequences of these cuts here in Alberta:

Questions and confusion

Prior to June 2012, all refugees and refugee claimants had access to health care services including basic medications, dental, and vision care. Their coverage was equivalent to what low-income Canadians receive on social assistance programs. 4 Since the changes to the IFHP, coverage is now divided into several tiers with differing levels of benefits. Some categories of refugee claimants do not even have coverage for life-saving treatment unless they pose an immediate public health risk to the community. 2 The new system can be challenging to navigate and understand. This has resulted in physicians and administrators not knowing who and what is covered and many cases of patients being wrongfully turned away.10,11

Increased costs to the system

There are now many refugee claimants who cannot access a family physician or medicentre and who cannot afford the medications they need to treat illnesses like heart disease, asthma, diabetes, and depression. 4 Some of them do not even have a diagnosis because blood tests, x-rays, and ultrasounds are often not covered. 2 Torture survivors are being denied psychiatric services. Pregnant women are being asked to pay up-front for basic pre-natal screening and care. 12 Children are not be eligible for checkups. 8 The result of all of these barriers is that refugees and refugee claimants with treatable conditions may not access medical care until quite late, increasing their risk of disease progression. As such, we miss out on the opportunity to prevent serious complications and keep people out of the hospital. There are reports from around the country of refugees and refugee claimants arriving to the emergency department with complications of untreated medical problems. 12 Not only is this much more expensive than treating the condition before it worsens, it also has the potential to increase emergency room wait times. 4,14

Following a hospital stay or emergency room visit, many refugee claimants receive a bill that they are unable to pay. Hospitals and ultimately the province are left to absorb unpaid medical bills. 13 Thus the cost of these preventable hospital admission and emergency room visits are inevitably put back on to Albertans.

Risks to the individual, risks to the public

The cost of health care services may deter refugee claimants from seeking any form of medical attention. This limits the opportunities to diagnose and treat important infectious illnesses.4 Not only does this worsen the health status of refugee claimants, it also increases the chance of Albertans being exposed to these illnesses.

Hurting the next generation of Albertans

Nearly 40% of refugee claimants have their applications approved.15 That means that a large proportion of refugee claimants will go on to become Canadian citizens. By limiting their health care during the application period, we are merely setting them up to be in worse health as future Alberta citizens and sabotaging their chances of adapting and thriving here. 16 Furthermore, many pregnant refugee claimants will not have access to pre-natal care or screening.2 Yet, their children are born as Canadian citizens with full access to health care services. Providing pre-natal care to pregnant refugee claimants will protect the health of their soon to be Canadian babies, costing far less than the expense of having to deal with the complications arising from the lack of pre-natal care.

A temporary solution to an immediate crisis

The current refugee health care system is flawed, and this hurts all Albertans. While we can hope that the federal government reverses the cuts and reinstates full coverage, we cannot afford to sit idly and wait. Other provinces have recognized the urgency of this issue and have stepped in to fill the gaps left by the federal cuts. 5,6 We need to do the same. Every day we wait is only costing more money, making refugees sicker, and putting us all at risk.

Small cost, big gain

We are asking the Government of Alberta to restore medical coverage to refugees and refugee claimants back to where it was before the 2012 cuts. The Quebec government estimates that the cost of providing health benefits to refugees and refugee claimants will be $4.7 million per year. 17 When adjusting that total for the number of refugees here in Alberta, it comes out to approximately $2.3 million or 63 cents per Albertan per year. 18

A success story for Alberta

"I had a successful professional and personal life in my country. Due to unforeseen extreme circumstances I saw my life being torn into pieces and out of fear I left my country one day. I became a refugee. I never thought that being alone in a new country, culture, language was that scary, but there I was. I became one of many people asking for refuge in 2001. I learned I was pregnant during my immigration medical exam I was scared and alone, new to Canada, a country I knew very little about and the one who made me feel welcome and relieved that my life was no longer in danger. With the help and support of the government I was given a second chance to get my life back. I was given support to give birth and raise my children, as well as helping them to stay healthy. This would have been almost impossible without the governments assistance. Knowing that I had access to healthcare and social services gave me and my family the opportunity to become successful and socially useful as well as an example for others to carry on working for this country that has become our own as well."
- Maria Martinez-Jaraba, PGY4 Public Health & Preventive Medicine, University of Alberta

In summary:
What are we asking for?
We are asking for the Government of Alberta to cover the cost of providing essential health care to refugees and refugee claimants to fill the gaps caused by the cuts to IFHP.

How much will this cost?

$2.3 million dollars, or 63 cents per Albertan per year.

How can you get involved?

Sign our petition to let our provincial leaders know that refugee health is our health. In conclusion, providing interim comprehensive health care for refugees and refugee claimants is beneficial for all Albertans. The short term saving for the federal government are translating into long term costs for provincial health care systems, and Alberta is no different. The downloading of health care costs to the provinces are best addressed by a comparatively small investment now for much bigger cost savings in the future.

For Alberta, stepping up to cover health care costs for refugees and refugee claimants is not only good social policy, but is also sensible economic policy. Refugee Health is Our Health.
for more information contact: Alberta Refugee Care Coalition ARCChealth@gmail.com or "Like" and "Follow" us for updates: https://www.facebook.com/ARCChealth https://twitter.com/ARCChealth

References:

1. News Release - Reform of the Interim Federal Health Program ensures fairness, protects public health and safety. Citizenship and Immigration Canada. April 25, 2012. http://www.cic.gc.ca/english/department/media/releases/2012/2012-04-25.asp Accessed October 5, 2013. 2. Interim Federal Health Program: Summary of Benefits. Citizenship and Immigration Canada. Government of Canada. Accessed Oct 10, 2013. http://www.cic.gc.ca/english/refugees/outside/summary-ifhp.asp 3. Arya, Neil. et al. Enter at your own risk: government changes to comprehensive care for newly arrived Canadian refugees. Canadian Medical Association Journal. 2012 184(17). 1875-1876. 4. Barnes, Steve. The Real Cost of Cutting the Interim Federal Health Program. Wellesley Institute. October 2013. http:// www.wellesleyinstitute.com/wp-content/uploads/2013/10/Actual-Health-Impacts-of-IFHP.pdf 5. Robert Dutrisac, Demandeurs dasile - Le Qubec se veut plus humain, dit De Courcy, Le Devoir, February 12, 2013. Accessed via http:// www.cocqsida.com/assets/files/Demandeurs%20asile%20Le%20Qc%20se%20veut%20plus %20humain_ledevoir_12fev2013.pdf. 6. Winnipeg Free Press, Manitoba to cover refugee health benefits, send Ottawa the bill, http://www.ipolitics.ca/2012/09/13/ manitoba-to-cover-refugee-health-benefits-send-ottawa-the-bill/ 7. Joint letter to the Minister of Citizenship and Immigration, the Hon. Jason Kenney, from Canadian Association of Optometrists, Canadian Association of Social Workers, Canadian Dental Association, Canadian Medical Association, Canadian Nurses Association, Canadian Pharmacists Association, College of Family Physicians of Canada, and The Royal College of Physicians and Surgeons of Canada, 18 May 2012. http://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/ SuppBenefitsKenneyEN.pdf 8. Samson, Linday and Hui, Charles. Cuts to refugee health program put children and youth at risk. Canadian Pediatric Society. June 2012.http://www.cps.ca/advocacy/CPS_RefugeeHealth.pdf 9. Changes to the Interim Federal Health Program: Policy Statement. Canadian Healthcare Association. November 2012. http:// www.cha.ca/wp-content/uploads/2012/11/IFHP-reform-policy-statement-November-2012.pdf 10. Keung, Nicholas. Impact of refugee health cuts: confusion, unnecessary costs and compromised care. The Toronto Star. September 28, 2012. Web. http://www.thestar.com/news/canada/2012/09/28/ impact_of_refugee_health_cuts_confusion_unnecessary_costs_and_compromised_care.html Accessed October 15, 2013. 11.Mellor, Clare. Refugees health at risk. Herald News, Halifax. October 11, 2013. Web. http://thechronicleherald.ca/metro/ 1160150-refugees-health-at-risk 12.Canadian Doctors for Refugee Care. Further Reading & Survey. Refugee Health Outcome Monitoring and Evaluation System. http://www.doctorsforrefugeecare.ca/further-reading-survey.html. Accessed October 15, 2013. 13. Keung, Nicholas. Ontario Hospitals Absorb Health Costs to Treat Refugees. The Toronto Star. June 8, 2013. Web. http:// www.thestar.com/news/immigration/2013/06/08/ontario_hospitals_absorb_health_costs_to_treat_refugees.html. Accessed October 5, 2013. 14. Caulford, Paul. Health care for Canadas medically uninsured immigrants and refugees: Whose problem is it?. Canadian Family Physician. 2012 58 (7) 725-727. http://www.cfp.ca/content/58/7/725.full 15. Refugee Status Determinations 1989-2011. Immigration and Refugee Board, Government of Canada. http://www.cdphrc.uottawa.ca/projects/refugee-forum/projects/documents/REFUGEESTATSCOMPREHENSIVE1999-2011.pdf Accessed October 19, 2013. 16. Jackson, Samantha. The New Interim Federal Health Program: How Reduced Coverage Adversely Affects Refugee Claimants Employment. Ryerson Centre for Immigration and Settlement, Ryerson University. November 2012. http://www.ryerson.ca/ content/dam/rcis/documents/RCIS_Research_Brief_No_1.pdf 17. Boyle, Theressa. Health ministers tackle refugee health cuts, assisted suicide. Toronto Star. October 3, 2013. Web. http:// www.thestar.com/news/canada/2013/10/03/rona_ambrose_ottawa_will_discuss_assisted_suicide_but_wont_legalize_it.html Accessed Oct 20, 2013. 18. Calculated using refugee numbers from: Facts & Figures 2012 - Immigration Overview: Permanent and Temporary Residents. Citizenship & Immigration Canada. http://www.cic.gc.ca/english/resources/statistics/facts2012/permanent/12.asp Accessed Oct 18, 2013. 19. YOOtheme. (Designer). (2010, October 23). Blue, facebook, social icon [Web Graphic]. Retrieved from https:// www.iconfinder.com/icons/60823/blue_facebook_social_icon 20. YOOtheme. (Designer). Twitter, white icon [Web Graphic]. Retrieved from https://www.iconfinder.com/icons/60858/ twitter_white_icon