By Y.Y. Brandon Chen
and Vanessa Gruben
University of Ottawa
Despite changes to Canada’s refugee health-care program in April 2016, many people still don’t have adequate access to care, according to a series of interviews we conducted recently with refugee service providers in Ottawa.
Health care for refugees in Canada is the responsibility of the Interim Federal Health Program (IFHP), and it has had some tumultuous years. In June 2012, the federal government made significant cuts to the program, leaving many refugees and refugee claimants without access to publicly-funded health care, while causing serious confusion among providers.
Health-care advocates challenged the cuts in the Federal Court. In 2014, the court found the cuts violated the Charter of Rights and Freedoms as they were “cruel and unusual.” Following a change in government, the IFH was fully restored to its pre-2012 form in April 2016.
The reinstatement of IFHP was widely applauded – but it hasn’t lived up to its promise. The program, in theory, provides all refugee claimants with hospital and medical care coverage, and provides all refugees and refugee claimants with supplementary coverage similar to that received by low-income Canadians.
But our interviews with refugee service providers reveal that, despite reinstatement, the IFHP remains plagued by “a legacy of confusion,” as one practitioner put it. Because of the cuts in previous years, many walk-in clinics, pharmacies and specialists continue to deny services to refugees and refugee claimants, based on the false assumption that they’re not covered by IFHP.
Even when service providers are aware of IFHP’s restoration, some are hesitant to see patients due to the program’s perceived complexity. To be reimbursed by the program, practitioners must register with the program, which many report as a cumbersome and slow process.
Once registered, many providers complain about having trouble figuring out which services and treatments are covered. And the time it takes for providers to be paid by IFHP seems to be inconsistent: while some providers have received reimbursement quickly, others have had to wait up to 90 days.
Many people expected that the reinstatement of IFHP would reverse problems related to care access encountered by refugees and refugee claimants during the years of cutbacks. The government claimed the renewed coverage would improve refugees’ health outcomes. But a year later, this promise has not translated into reality.
Certainly, the government’s decision to restore IFHP has made a positive difference. Many previously uninsured persons can now obtain medically-necessary treatment. Health-care providers can focus on treating patients, rather than worrying about how patients would pay for care.
But the picture is far from perfect.
The federal government must do more to protect and promote refugees’ health and well-being, and make the promise of IFHP a reality for all.
So what should be done?
- More resources must be devoted to educating health-care providers about the reinstated IFHP. Public education must also target refugee service providers outside the health-care field, refugee sponsors and refugees. This will better allow refugees and their allies to advocate for patients whose access to services is inappropriately denied.
- IFHP registration and reimbursement procedures should be streamlined to encourage health professionals’ participation in the program. Communications between IFHP administrators and refugee service providers should also be improved so questions about the program can be answered promptly.
- Coverage for medical interpretation services must be expanded. The program pays a modest amount for interpretation during refugees’ post-arrival health assessment and when refugees access mental health care. This coverage is not enough. As many refugees are not yet proficient in English or French, their ability to fully access care depends heavily on trained interpreters.
It has long been recognized that the extension of public health care is a critical first step in ensuring vulnerable people’s access to care. A year ago, the federal government took this all-important step with respect to refugees.
Now, it’s time for the government to ensure all refugees arriving in Canada actually receive the health care they need.
Y.Y. Brandon Chen and Vanessa Gruben are law professors and members of the University of Ottawa’s Centre for Health Law, Policy and Ethics. They are co-leading a study on refugee service providers’ experience with the reinstated Interim Federal Health Program.