In the last decade, healthcare coverage for some of the most vulnerable has been a roller coaster. Refugees in Canada have historically been provided with healthcare coverage for vision, dental, emergency and primary care while they wait on their status decision, called the Interim Federal Health Program (IFHP). The main difference with this health coverage is that the cost is covered Federally, instead of Provincially.
In 2012, the Government of Canada announced that they were reducing or eliminating the benefits for those who were previously eligible to this program as a cost saving measure. They estimated that it would save over 100 million over five years (Bakewell et al., 2018).
This change in refugee care caused an uproar in Provinces, hospitals, and refugee advocates who argued that these changes would exacerbate chronic illness or create sicker refugees because those who could not afford care would avoid it until it was an emergency (Canadian Doctors for Refugee Care v. Canada, 2014). This exacerbated conditions that could have been treated cost-effectively at earlier stages. (Piccininni et al., 2020)
Refugee healthcare in Canada continues to progress beyond the changes in 2012 with a full re-instatement of the IFHP program in 2016. Discussions on how to support refugees diagnosed with chronic diseases in Canada are taking place with representatives from government, settlement agencies, health charities, and refugees to explore the scope of the challenges ahead (UNHCR, 2018). The importance of multidisciplinary strategies to create better and more inclusive access were highlighted for their success in regions of Canada. It is acknowledged that the Canadian healthcare system can be a challenge for new arrivals to navigate. Those providing care to refugees with chronic illness have found that ease of access to large health teams where they can easily access physicians, nurses, social workers, settlement workers, dieticians, or psychologists have improved rates of refugees in continued care (UNHCR, 2018)
There are still barriers to some health services under the IFHP. Mental health coverage, women’s health, and pre-natal care coverage could be increased (Piccininni, 2020). Refugees have often already experienced extreme hardship and possibly inhumane conditions, leading to health concerns that are unique for the population. When asking a group of primary care physicians what their ranked top priority conditions for refugees were: abuse and domestic violence, anxiety and adjustment disorder, cancer of the cervix were listed as the top three selections with pregnancy screening, and post traumatic stress disorder also included on their list of concerns as well (Swinkels et al., 2011).
This demonstrates a gap in what the identified priorities are for refugee health, and what is well covered under the IFHP. Strengthened mental health coverage would help with many of the priority conditions listed above. Prenatal care is also recommended for all pregnant women in Canada, and should be equally accessible and comprehensive to refugee women. It makes business sense as well as one study estimates that for every US $1.00 spent on pre-natal care, resulted in savings of US $2.20 in newborn care within the first 60 days of life (Buescher et al., 1991).
The future of refugee care in Canada must continue to evolve by improving access to health through multi-disciplinary team and prioritize modernizing the IFHP to also include improved coverage for the priority diseases as determined by those who know their care the most – their primary care physicians, not politicians.
References
Bakewell, F., Addleman, S., Dickinson, G., & Thiruganasambandamoorthy, V. (2018). Use of the emergency department by refugees under the Interim Federal Health Program: A health records review. PloS one, 13(5), e0197282. https://doi.org/10.1371/journal.pone.0197282
Buescher, P. A., Roth, M. S., Williams, D., & Goforth, C. M. (1991). An evaluation of the impact of maternity care coordination on Medicaid birth outcomes in North Carolina. American journal of public health, 81(12), 1625–1629. https://doi.org/10.2105/ajph.81.12.1625
Canadian Doctors for Refugee Care v. Canada (Attorney general), 2014 FC 651 (CanLII), http://canlii.ca/t/g81sg
Piccininni, C. & Kwong, M. (2020) Refugee Health Care Funding in Canada. University of Western Ontario Medical Journal. 88(1):40-2 doi: https://doi.org/10.5206/uwomj.v88i1.6182
Swinkels, H., Pottie, K., Tugwell, P., Rashid, M., & Narasiah, L. (2011). Development of guidelines for recently arrived immigrants and refugees to Canada: Delphi consensus on selecting preventable and treatable conditions. Canadian Medical Association Journal, 183(12), E928-E932. https://www.cmaj.ca/content/183/12/E928.full
United Nations High Commissioner for Refugees. (2018) Pieces of Glass: A Mosaic of Solutions. Report of the Forum on Refugees and Chronic Disease. HealthPartners Canada. https://www.unhcr.ca/wp-content/uploads/2019/01/Chronic-Disease-Report_EN.pdf