We are clinicians and health system researchers. Through both our clinical and academic work, we bear witness to a health system that is under great pressure, with more sick patients and fewer hospital beds and resources to meet their needs.
Today, Oct. 18, the province will ask Albertans whether some of the people living and working among us are to blame. Three of the 10 referendum questions target people with temporary status. They would restrict provincially funded programs to citizens, permanent residents and holders of an undefined “Alberta-approved” status; impose a 12-month wait for social supports; and charge a “reasonable fee or premium” for health care and schooling. The Premier has floated $1,900 a year per person.
An informed vote, however, should depend on what the evidence shows. And the evidence does not support these proposals.
Start with cost. The Premier’s office says temporary workers and international students account for 1.27 per cent of tracked health costs while making up about 5 per cent of Albertans. That is roughly $1,600 per person a year: less than the proposed $1,900 per person premium, and about a quarter of what the province spends per Albertan. Most temporary residents are between 20 and 34, representing a young, productive and healthy group that uses very little health care. Research shows they are hospitalized 40 to 60 per cent less often than permanent residents, who in turn, are hospitalized about 45 per cent less than Canadian-born residents. They already contribute to health and social services through income tax, GST and, through rent, property tax.
A $1,900 premium is not cost recovery; it is a tax on immigration status.
The real bottlenecks in the health system are well known – not enough staff, hospital beds and continuing care spaces. About one in seven acute care beds in Alberta holds a patient waiting for care elsewhere, often an elder waiting for continuing care, and that backs patients up into emergency departments. Last fiscal year, Alberta ended with 21 fewer acute care beds while its population grew by about 2.5 per cent.
Immigrants, both permanent and temporary residents, help hold the system up. They are 37 per cent of Canada’s physicians and 42 per cent of its nurse aides. In Calgary, immigrants comprise seven in 10 nurse aides, orderlies and patient service associates. Making this province appear unwelcoming to newcomers by limiting access to social programs may hinder efforts to recruit much-needed health-care workers
Restricting care also costs more in the long run. When patients delay seeking care due to cost or other access barriers, this shifts the burden to the emergency department, where patients arrive later, sicker and costlier to treat, lengthening waits for everyone. When Germany restricted asylum seekers’ access to care, costs increased 39 per cent per asylum seeker.
Restricting access to care also can be deadly. After Spain cut undocumented migrants from coverage in 2012, economists estimated about 80 extra deaths a year; Spain reversed course in 2018. When Ottawa cut refugee health coverage in 2012, we watched sick children turned away from Alberta’s emergency departments. The Federal Court called the cuts “cruel and unusual” and coverage was restored.
The pressures Albertans feel are real. But these questions target those among the youngest and healthiest residents while leaving the real bottlenecks untouched. On the evidence, these proposals will not shorten a single wait. They will raise costs and make it harder to staff the health system we all depend on.
