Passing the buck: cuts to the Interim Federal Health Program will just mean greater costs for the provinces

The Interim Federal Health Program (IFHP) was established in 1957 to provide temporary coverage of medical costs for refugee claimants without financial means while they await qualification for provincial or territorial coverage. Citizenship, Immigration and Multiculturalism Minister Jason Kenney recently introduced changes to the IFHP that have prompted outcry across the country from physicians and allied health professionals who work closely with refugees. These changes mean that refugee claimants from designated countries of origin (DCO – countries that do not normally produce refugees, respect human rights and offer state protection) will no longer be eligible for coverage unless their condition constitutes a public health emergency, while refugees from non-DCO countries will no longer receive supplemental medical care such as pharmaceuticals or dental care. Ironically, this means that many refugees will have received more comprehensive care at refugee camps in developing nations than they will be provided upon seeking sanctuary in Canada.

This shift in funding has sparked outrage from the medical community as it not only compromises the commitment to humanitarianism implied through welcoming refugees, but will also result in potentially dangerous patient outcomes and increased long term costs. This is particularly detrimental to provincial governments who will be forced to absorb the costs resulting from federal abdication of responsibility for refugee care. While the federal government’s rhetoric has focused on determent of “bogus refugees” and the unfairness of offering supplementary services not available to the general population, there has been an intentional disregard for the public health and economic consequences of eliminating access to primary care for legitimate claimants. This is representative of a greater trend of shortsighted federal divestment from key social determinants of health that will ultimately manifest in greater health expenditures long term.

In my experience working with refugees through Ottawa’s Health Advocacy for Refugees Program (HARP), it is incredibly evident that the unique social context of the refugee experience warrants special consideration of health care needs. While the proposed changes promise to protect public health through coverage for treatment of communicable diseases such as tuberculosis or HIV, the assumption that high-risk individuals will be easily identified in the absence of regular primary care contact is flawed. Instead, the history of trauma and abuse endemic among refugee populations often prevents individuals from willingly seeking medical care. Furthermore, refugees often arrive in Canada following nearly lifelong exposure to environments of disease that render them in desperate need of the supplementary services that they will be denied through these amendments. Denying access to dental care for a child who arrives with a mouth abscess will often result in the need for hospitalization later.

Ultimately the motivation of cost-savings will be lost through these cuts, as denial of primary care to high-risk patients is well understood to cost more over the long term. This basic economic principle largely justifies current funding of supplementary services, pharmacare included, for vulnerable Canadians such as the elderly or those receiving social assistance. The decision to defund access to medications for chronic conditions, such as insulin for diabetics or cholesterol-lowering medications post-heart attack, will only result in worsening of those conditions, which will ulitmately require costly interventions such as intensive care admission or surgery. This cost burden will inevitably be shifted to provinces, as successful refugee claimants receiving provincial coverage will present with more severe (and expensive) conditions after remaining untreated for prolonged periods.

Perhaps most egregious among the proposed changes is the decision to cut emergency services completely for refugees from DCO countries unless their condition constitutes a public health emergency. Shockingly, Citizenship and Immigration Canada goes so far as to say that a DCO claimant who suffers from a medical emergency such as a heart attack will receive no care. Similarly, pregnant DCO claimants will be denied coverage of pre-natal care or delivery. This denial of potentially life-saving care fundamentally contradicts Canadian values and greatly challenges our international reputation on human rights. Certainly, these changes are in shamefully stark contrast to the suggestion of refuge.

The changes discussed are scheduled to take effect on June 30. Health care providers across the country are rallying the federal government to reconsider this action. Provincial governments should also be vocal in opposing the federal government’s misdirection, as they will ultimately bear the cost of the economic and public health implications of these cuts. This is not enough, however, as a reversal of the proposed changes will require significant public opposition. Contact Minister Kenney (jason.kenney@parl.gc.ca, @kenneyjason) as well as your local MP and MPP to let them know that Canadians will not stand for such a costly attack on our most vulnerable residents.