Restoring Healthcare for Refugees in Ontario: Unrealistic Expectations on Healthcare Providers

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Source: americanbar.org

Introduction

Following in the footsteps of many other provinces, Ontario, beginning in January 2014, has reinstated standard healthcare coverage for certain groups of refugees who had coverage cut by significant changes to the Interim Federal Health Program (IFHP).

Previously, refugee claimants originating from countries which are less likely to produce refugees and rejected refugee claimants were granted healthcare coverage ONLY IF it was to diagnose or treat conditions which posed a threat to the “public” (read: Canadians). This meant, for example, that pregnant women and diabetics, were not covered for their medical needs.

The new Ontario program elevates the healthcare coverage of these two groups to a level which is comparable to the services covered under OHIP, at least officially.

A paperwork nightmare

While these changes are welcome, the burden placed on healthcare service providers is substantial. For service providers to be reimbursed by the Ontario government for providing services to these groups, they are expected to do the following for every single service provided:

1) Apply to the IFHP

2) Receive the rejection of coverage from IFHP

3) Apply to the Ontario program

4) Receive reimbursement

For a healthcare system which is already understaffed and overworked, placing these procedural burdens on service providers threaten the healthcare access of some of the most vulnerable people in our society. When certain service providers decide that these submission requirements are too onerous and turn patients away, it is the refugee claimants that suffer.

While these changes do, in theory, reinstate healthcare coverage for groups whose coverage were previously restrained, the complex claims procedure risks threatening the ability of these groups to effectively access healthcare services as many healthcare providers will simply refuse to take on the paperwork burden.

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2 thoughts on “Restoring Healthcare for Refugees in Ontario: Unrealistic Expectations on Healthcare Providers

  1. I wonder if you can give some context on the issue? I saw the IFHP form and it is 2 pages long. It seems like it is processed in 4 weeks, which is lightning fast for the federal government. End to end how long is the process? I also took a look at the DCOs, and the list seems sensible, but my knowledge of human rights violations is no better than average. I feel like the fear that people are making bogus refugee claims to access our health care is not far fetched.

    That said, your argument seems to be that one way or the other, these people will get some form of health care either from the federal gov’t or the provincial one and why make them jump through so many hoops. That definitely rings true for pregnant women, but how then can we combat abuses of our health care system by bogus applicants?

  2. Regarding processing times:

    I’m not sure how long a PASPO application takes, but even if it takes the same amount of time, that is 8 weeks and two application forms for every single service provided. Another point is that healthcare providers are not only expected to submit these applications, but understand where someone is in the refugee determination process. When you consider the appeals and revisions that are available at many stages, figuring this out is not always the easiest thing to do. The issue is that these burdens are being placed on healthcare providers, many of whom do not have the time to deal with this paperwork and research and will probably end up denying services to people who are eligible.

    Regarding abuses of our healthcare system:

    The conservative government relies on black and white characterizations of so many issues, and this is highly problematic. The overwhelming majority of refugee applicants (at least in my opinion and experience) are neither “ideal” nor “bogus” refugees. The real stories of people who claim refugee status usually fall somewhere along a spectrum. With such a high threshold of proof required to be accepted as a refugee, many people fall below the threshold but are in no way “bogus” applicants. A refused refugee claimant does not automatically mean someone is taking advantage of Canada, many just have not met the threshold but have gone through the process in good faith.

    The same black and white characterization is evident in the designation of certain countries as being less likely to produce refugees. Even if this were true for most countries on this list, why are we making judgement calls about the authenticity of refugee claimants before their hearing?

    There is also evidence that those with restricted access just end up in already crowded emergency rooms with problems that could have been easily avoided if they had standard healthcare access (see this report by the Wellesley Institute: http://www.wellesleyinstitute.com/wp-content/uploads/2013/10/Actual-Health-Impacts-of-IFHP.pdf).

    Finally, even if someone does not tell the truth in a refugee hearing, does that really mean that they should not have access to healthcare? After all of the work I’ve done with all sorts of refugee claimants, I have a fundamental problem taking this step. Keep in mind that with all of the changes that have been made to the refugee determination process, we are talking about a few months (rather than a few years as it was before).

    Phew! I hope this helps!

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