Every year, thousands of refugees arrive in Canada seeking safety and a new beginning. For many, however, the promise of a fresh start is overshadowed by significant barriers to essential health-care services.
Refugees often face language barriers, cultural differences and a lack of knowledge about our health-care system, which can lead to delays in receiving care and poorer health outcomes. Adding to their difficulties are the bureaucratic intricacies of programs like the Interim Federal Health Program (IFHP), which covers refugee claimants and provides coverage for basic medical services, including hospital services, labs and imaging, as well as supplemental services such as dental care, vision care, physiotherapy, occupational therapy and prescription drug coverage.
For many refugees, establishing a connection to health care is vital, especially for those who may have been disconnected from primary care for extended periods. Regular access to health-care services is not only essential in addressing immediate health concerns but also for the prevention and management of acute and chronic diseases. By focusing on preventive care and early intervention, health-care professionals can significantly enhance cost-effectiveness and improve overall health outcomes. Understanding the unique challenges these individuals face allows health-care providers to ensure they receive the comprehensive care they desperately need.
Refugee claimants arrive in Canada without prior permanent residency and apply for refugee status within the country. They await a decision on their claim from the Immigration and Refugee Board of Canada (IRB). Upon arrival in Canada, refugee claimants receive a Refugee Protection Claimant Document (RPCD), also known as a “brown paper” that grants access to the IFHP.
The problem, however, is that numerous clinics, notably in Toronto, which hosts a substantial portion of Canada’s refugee population, do not accept insurance through IFHP.
Physicians’ services covered by the IFHP are billed through Medavie Blue Cross instead of provincial or territorial health plans. To obtain these reimbursements, providers must register with Medavie Blue Cross. The registration process is straightforward, requiring only verification of professional credentials, basic provider information and direct deposit setup.
Knowing this, we consulted local physicians and refugee centres to understand why many refugee claimants still have difficulty accessing health care with the IFHP.
Local physicians highlight a significant knowledge gap, noting that many health-care providers are unaware of the IFHP or how to enroll in it. A study conducted by Vanessa Redditt and colleagues in 2018 exploring the enrollment of primary care providers in the IFHP program in the Greater Toronto Area found that nearly 30 per cent of providers were unfamiliar with the IFHP program, and about 15 per cent did not know how to enroll. This lack of awareness prevents numerous providers from offering services to refugees. Additionally, the study revealed that 45 per cent of sampled providers were not seeing any refugees in their practice. As such, a significant effort is needed to educate healthcare providers on the IFHP program.
Carol Makutsa, a settlement staff member at the Christie Refugee Welcome Centre, further emphasizes this issue: “There can be complications related to billing and insurance coverage, especially if the provider is unfamiliar with how to handle claims under the IFHP. This can result in reluctance to accept patients with IFHP due to concerns about compensation or reimbursement.” Educating clinic administrative staff also is crucial as they are often the first point of contact for refugees. A lack of understanding among administrative staff can lead to misinterpretation of the documentation, resulting in refusal of service.
Based on insights from local physicians and refugee centres, the primary step toward improving refugees’ access to health-care services is education and training to encourage more providers to register and understand the billing process. As Redditt says, “Increasing the number of IFHP-registered providers and ensuring clinic staff are familiar with the program are critical steps toward improving access to care to newly arrived refugees and claimants.” By enhancing education, we can reduce the number of refugees turned away from necessary health-care services and ensure they receive the care they need.
