It's been over a year since Canada's government reversed cuts to the health-care program for refugees and asylum-seekers.
The move reinstated basic health care and supplemental services — such as dental and vision services — for newcomers who aren't yet eligible for provincial health coverage.
Liberals patted themselves on the back for the move, while refugees and their advocates celebrated the reinstatement. Great stuff, right?
Except one year later, despite the policy change, many new arrivals continue to be left without adequate access to health care. That's the finding that comes out of a series of interviews we recently conducted with refugee service providers in Ottawa.
Health care for refugees in Canada falls under the responsibility of the Interim Federal Health Program (IFHP), which faced significant cuts back in June 2012. The Conservatives defended the cuts at the time, saying that "bogus asylum claimants" shouldn't be getting better health care than Canadian taxpayers.
Health-care advocates challenged the changes in the federal court, which, in 2014, found the cuts violated the Charter as they were "cruel and unusual." Following a change in government, the IFHP was fully restored to its pre-2012 form last April.
The reinstatement hasn't lived up to its promise, however.
'Legacy of confusion'
Our interviews with refugee service providers reveal that the IFHP remains plagued by "a legacy of confusion," as one practitioner put it. Because of the cuts in previous years, many walk-in clinics, pharmacies, specialists and GPs continue to deny services to refugees and refugee claimants based on the false assumption that they are not covered by the IFHP.
Even when service providers are aware of the IFHP's restoration, some are hesitant to see IFHP patients due to the program's perceived complexity. To be reimbursed by the program, health-care practitioners must first register with the program, which many report as a cumbersome and slow process.
Once registered, many service providers complain about having trouble figuring out which services and treatments are covered. They can call Medavie Blue Cross — the insurance company contracted by the federal government to run the IFHP — to ask questions. However, service providers we interviewed complained about being put on hold for a significant length of time.
What's more, the time it takes for providers to be paid by the IFHP seems to be inconsistent: while some providers have received reimbursement quickly, others have had to wait up to 90 days.
Certainly, the government's decision to restore the IFHP has made some positive difference; many previously uninsured persons can now obtain medically necessary treatment. Health-care providers can now focus more on treating patients, rather than worrying about if patients can afford to pay for care. But the picture is far from perfect.
Fixing the problem
So what should be done?
First, more resources must be devoted to educating health-care providers about the reinstated IFHP. Public education must also target refugee service providers outside the health-care field: refugee sponsors and refugees themselves. This will better allow refugees and their allies to advocate for patients whose access to services is inappropriately denied.
Second, the IFHP registration and reimbursement procedures should be streamlined to encourage health professionals' participation in the program. Communications between IFHP administrators and refugee service providers should also be improved so that questions about the program can be answered promptly.
Third, coverage for medical interpretation services must be expanded. Currently, the program pays a modest amount of interpretation during refugees' post-arrival health assessment and when refugees access mental health care. This level of coverage is not enough. As many refugees are not yet proficient in English or French, their ability to fully access health care depends heavily on trained interpreters.
It has long been recognized by health experts that the extension of public health care is a critical first step in ensuring vulnerable people's access to care. A year ago, the federal government made this all-important move with respect to refugees. But the swipe of a pen is not enough.
The government should go further and ensure that all refugees arriving in Canada actually receive the health care they need, and the benefits the Liberals promised would be restored.
Y.Y. Brandon Chen and Jamie Chai Yun Liew are law professors and members of the University of Ottawa's Centre for Health Law, Policy and Ethics. They are currently co-leading a study on refugee service providers' experience with the reinstated Interim Federal Health Program.