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The new refugee health care plan – am I understanding it correctly?


Starting July 1st, 2012, the Government plans to eliminate health care services to some refugee claimants and significantly reduce services to others.  Refugee claimants will get basic health care in urgent/essential situations, i.e., if they are rushed to the hospital or if they have communicable diseases such as tuberculosis, which could pose a risk to Canadians.  Refugees will no longer get supplemental care.  So no dental care, no vision care, no lab tests, no medications, no vaccinations, no referrals, no specialists, no counselling. 

The Government expects to save taxpayers about $100 million over the next five years or an average of $20 million a year. There were ~34,000 new refugee claimants in 2009; about 22,000 in 2010 and ~ 25,000 in 2011.  That’s an average of 27,000 refugee claimants per year who will get little health care, saving us ~ $740 per refugee per year. 

Under the new plan, refugees must access health care through an over-extended ER.  I think there are a few questions that a reasonable citizen could ask. Will someone at ER be doing an assessment of how “urgent” or “essential” a refugee’s health care need is? Will they be moved to the bottom of the wait list behind taxpayers? Who decides what “essential” is? Is prevention considered essential? Will there be vaccinations for refugee children? Medications and tests for pregnant refugee women?; diagnostic testing for disabilities or birth defects?  How likely is it that we won’t know about refugees’ health issues until it becomes an emergency or a critical, chronic, terminal issue and cost us hundreds of thousands of dollars? 

I am not sure I understand the cost-benefit of this new plan. So, I did some digging.  While the data I unearthed are dated and vary by province (some are even apples and oranges), they offer some insight. Here are two examples: A refugee child can be vaccinated for meningitis for mere dollars (or for free as my daughter was) or be hospitalized for ~ $3,100 if he/she gets sick with meningitis (Alberta data; includes facility and physician fees). The average cost of a pre-natal visit is also modest (~$29 in 2004-2005 in BC, for example).  But, in the absence of pre-natal care and education, we may spend $1,400 on a refugee woman, taken to hospital. That’s the average cost per female admitted for false labour in Canada in 2006.  According to the Star, prostate cancer screening test costs Ontario patients $30 (May 21, 2012).  Left undetected, I am sure the treatment costs are multiples more.  There is more such data from various Canadian sources, for those willing to dig through the reports.

Looks like it comes down to probabilities. The actual cost of immunization may be low now and the potential downstream cost of treating a refugee child sick with meningitis may be high, but only if the child becomes sick.  But what if the child doesn’t contract meningitis and an emergency never occurs? What if the refugee child is never brought to ER?  Looks like the government is guessing that the probability of sickness or emergencies is low and that we will likely not face the downstream high costs.  My concern is that we are gambling with “ifs” and “probabilities” on someone’s health or life – all for $740 per refugee per year. 

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  1. Micky Pinto

    Excellent article and assessment. But my understanding is that ER visits as well will only be covered IF it is deemed to be an emergency. So otherwise they are not going to pay. So the patient will be getting the hospital bill.
    In my opinion the governments plan is an over-reaction to a previously over-generous plan (why were we coverring dental for a refugee when we don’t cover it for anyone else). But it hard to convince the public that we should scale back these cuts when they see what the previous plan had.

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