What the refugee health cuts really cost
Nearly two years ago, the federal government made significant cuts to its Interim Federal Health Program, which allows refugees to access essential health services, such as medical testing and treatment.
As a result, many refugees have lost access to health care, medication coverage, vision and dental care. Furthermore, persecuted individuals from designated countries of origin, such as Hungary and Mexico, referred to by Immigration Minister Chris Alexander as “safe” countries, are only eligible for treatment of conditions deemed to be a public health or safety concern. The rationale for the cuts was that it would save taxpayers money and deter refugees from exploiting Canada’s health care system. Despite opposition from refugee patients, health care professionals and medical journals, the cuts have remained unchanged.
Since the cuts have been implemented, an emerging body of evidence confirms what was predicted: they are harmful and costly to the Canadian public. Early reports highlighted their negative consequences, including children who were unable to access tests for infectious diseases and pregnant women who were denied prenatal care. Some refugees are unable to receive basic primary care and treatment for chronic diseases, such as diabetes. Many of these incidents continue to be tracked by health care professionals through the Refugee Health Outcome Monitoring and Evaluation System. Interviews with service providers to refugees have also uncovered administrative barriers related to the cuts and confusion about eligibility for health care coverage. It’s alarming that some refugees are turned away from health care facilities or asked to pay an initial appointment fee.
A recent study conducted at The Hospital for Sick Children found that after the cuts were implemented, the proportion of emergency department visits from child refugees decreased, while the hospital admission rate of child refugees increased from 6.4% to 12%. Following the cuts, emergency department bills that were covered by the Interim Federal Health Program dropped from 46% to 7%. The proportion of SickKids’ emergency department bills for refugees that were unpaid increased from 54% to 93%. These early findings suggest that since the cuts have come into effect, child refugee admission rates have doubled and health care costs are being downloaded from federal levels to provincial bodies and hospitals.
Initially, the federal government projected $20 million in annual savings from cuts. However, the provincial governments have had to step up to cover refugee health care costs. Since January 1, Ontario has begun providing healthcare coverage for refugees. It’s been estimated that in Ontario, which is home to 55% of Canadian refugees, it will cost the province $20 million annually with their new plan to provide refugee health care. Quebec has instituted a similar plan, and Alberta is also considering one, at an estimated annual cost of $5 million and $2.3 million respectively. Notably, these estimates do not include other significant and relevant costs, such as transportation and lost work hours for refugees seeking health care or the numerous pro bono hours many health care professionals contribute. The costs may be above what the federal government projected as savings partly because many refugees have lost access to primary care services and are more acutely ill when they present at hospitals.
The past two years have shown the cuts are hurting some of Canada’s most vulnerable people, including child refugees. Moreover, they create unnecessary barriers for health care professionals. And they will not save taxpayers money in the long term, as health care costs are merely being shifted from one group to another. The 3rd National Day of Action took place on June 16, and the message remains the same: everyone deserves high-quality health care, regardless of where they’re from. Reversing the cuts is good for all of us.
Matthew To is a medical student and research student at @CRICH_StMikes, who tweets @matthewjto. Rebecca Jeffery is a medical student at Dalhousie University. Naheed Dosani (@NaheedD) is a palliative care resident physician at the University of Toronto, and Joshua To is a life sciences student at the University of Waterloo.