Class Notes (835,638)
Canada (509,305)
York University (35,236)
Sociology (802)
SOCI 3820 (21)
Lecture

The-Real-Cost-of-Cutting-Refugee-Health-Benefits.pdf

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Department
Sociology
Course
SOCI 3820
Professor
Eric Mykhalovskiy
Semester
Winter

Description
The Real Cost of Cutting Refugee Health Benefits: A Health Equity Impact Assessment SteveBarnes May,2012 The Policy Issue The Interim Federal Health Benefit (IFHB) provides temporary health insurance to refugees, protected per - sons, and refugee claimants in Canada who are not covered by a provincia▯l or territorial health insurance plan. This coverage is similar to what provincial and territorial insurance pla ▯ ns cover for Canadian citizens and perm -a nent residents. In some cases, in its current form the IFHB also covers ▯some supplemental services such as pre- scription drugs, dental, and vision care. In 2011, Canada accepted 12,983 refugee appli▯cations, a total of 38 percent of the applications received. The number of refugees accepted has fluctuated widely since 1989▯, with a high of 19,577 in 1991 and a low of ▯5,936 in 2007. The IFHB cost $84.6 million in the 2010-201▯1 fiscal year. 2 In April 2012, Citizenship, Immigration and Multiculturalism▯ Minister Jason Kenney announced changes to the IFHB, effective June 30, 2012. The changes would s▯ee access to health services for all refugees reduced or, in some cases, eliminated. In the new system, some categories of refugees w▯ould be eligible for health care cover- age only if it is urgent or essential and will have no access to prevent▯ative supplemental benefits, while other refugee categories will receive care only to prevent or treat a disease ▯posing a risk to public health or a condition of public safety concern, and some will be eligible for no coverage what▯soever. Applying a Health Equity Lens Policy decisions made far beyond the health care system can have significant health implications. Decisions about housing, income, education, or other underlying determinants of health can create negative health out - comes that affect the population as a whole, but vulnerable or marginali▯zed populations are often more severely impacted than other groups. It is therefore important to consider health▯ and health equity when making policy decisions that may affect the determinants of health. Health Equity Impact Assessment (HEIA) is a tool used to analyze a new▯ program or policy’s potential impact on health disparities and/or on health disadvantaged populations. A simp▯le health equity question should be applied to all policy decisions to determine whether the proposal could ▯have an inequitable impact on some groups, and, if so, which groups would be disproportionately affected. I▯f there could be a health impact, HEIA then facilitates policy-makers and planners to make changes to the plann▯ed policy to mitigate adverse effects on the most vulnerable and to enhance equity objectives. Finally, the HEIA tool assists in setting targets and meas- 3 urements to determine the policy’s success. This Health Equity Impact Assessment provides a high-level analysis of t▯he proposed changes to the IFHB. It identifies how changes to the IFHB that reduce access to health care w▯ill have negative health implications for all refugees, and that some refugees who will lose access to even basic health care services will be more severely – and inequitably – impacted. The HEIA also finds that women and▯ children will be disproportionately affected, and that this may have significant impacts on their physical and emoti▯onal safety. Changes to Canada’s refugee policies and the Interim Federal Health Benefit The federal government is currently pursuing significant reform to Canada’s immigration system, with parti-cu lar emphasis on addressing perceived fraud amongst asylum seekers. Citiz▯enship, Immigration and Multicul - turalism Minister Jason Kenney argues that Canada is currently receiving a disproportionate numbe▯r of refugee claimants from countries that are historically considered “safe.” 4 The Balanced Refugee Reform Act 2010 allows the Minister to identify Designated Co▯untries of Origin (DCO) that do not normally produce refugees and that respect human rights and offer state protection. Countries are likely to be considered safe if they have an independent judicial system▯, recognize basic democratic rights and 1 University of Ottawa Human Rights Research and Education Centre, IRB Refugee Status Determinations (1989-2011 Calenda▯r Years), http://www.cdp-hrc.uottawa.ca/projects/refugee-forum/projects/documents/REFUGEESTATSCOMPREHENSIVE1999-2011.pdf. 2 http://www.cic.gc.ca/english/department/media/releases/2012/201▯2-04-25.asp. 3 See Rebecca Haber, Health Equity Impact Assessment: A Primer, (Toronto: The Wellesley Institute, 2010) for a summary of HEIA. The Wellesley Institute has a range of Health Equity Impact Assessment tools ▯and resources, which are available at http://www.wellesleyin - stitute.com/policy-fields/healthcare-reform/roadmap-for-health-equity/▯heath-equity-impact-assessment/. The Ontario government has developed a HEIA tool: http://www.torontocentrallhin.on.ca/Page.aspx?id=2936. 4 http://www.cic.gc.ca/english/department/media/backgrounders/2012/20▯12-02-16i.asp. the wellesley instit1ute 2 freedoms, and have civil society organizations. The aim of the DCO policy is to “deter abuse of the refugee system by people who come from countries generally considered safe. Refugee claimants from DCOs would have their claims processed faster. This would ensure that people in need get protection fast, while those▯ with unfounded claims are sent home quickly through expedited processing.” The DCO policy has been criticized for placing too much control in the hands of the Minister, for not recognizing that ▯some people are unsafe even within ‘safe’ 6 countries, and for deeming some refugees as ‘worthy’ and others ‘▯unworthy’. In this context, Minister Kenney recently announced changes to the Interim Federal Health Benefit, which will 7 take effect on June 30, 2012.Currently, the IFHB provides temporary health insurance to refugees, protected pe -r sons, and refugee claimants in Canada who are not covered by a provincia▯l or territorial health insurance plan. The dependents of claimants are also covered. To be eligible, applicants must demonstrate that they are unable to pay for their own medical services and must not be covered by private▯ health insurance plans. Under the new IFHB, all refugee claimants in Canada will receive reduced▯ access to medical care, and some will not be eligible for any care, including emergency care. • Health Care Coverage will be available to refugee claimants from non-Designated Countries of Origin (DCO) and protected persons and includes coverage for hospital, physician, nurs ▯ e, laboratory, diagnostic and am-bu lance services if the services and products are of an “urgent or esse▯ntial” nature as defined in the Policy, as well as immunizations and medications only if required to prevent or tre▯at a “disease posing a risk to pub- lic health” or a “condition of public safety concern” as defi▯ned in the Order. • Public Health or Public Safety Health Care Coverage will be available to rejected refugee claimants and claimants from DCOs. Hospital, physician, nurse, laboratory and diagnost▯ic services, as well as immuniza- tions and medications, will be covered only if required to prevent or tr▯eat a “disease posing a risk to public health” or a “condition of public safety concern” as defined ▯in the Order. 8 Citizenship and Immigration Canada has provided examples of the coverage▯ available after the changes to the IFHB take effect, and a summary of proposed changes by refugee category ▯is included as an appendix. 9 5 http://www.cic.gc.ca/english/department/media/backgrounders/2012/20▯12-02-16i.asp. 6 The DCO policy has been particularly criticized for its potential impac▯t on Roma communities seeking asylum from Eastern Europe. See http://www.cbc.ca/news/politics/story/2012/02/15/pol-bogus▯-refugees.html. 7 Table adapted from http://www.cic.gc.ca/english/refugees/outside/summary-ifhp.asp. 8 http://www.cic.gc.ca/english/refugees/outside/coverage.asp. 9 Table adapted from http://www.cic.gc.ca/english/refugees/outside/coverage.asp. the real cost of cutt1ing refugee health be1nefits 3 CONDITION REFUGEE CLAIMANT REFUGEE CLAIMANT (DCO PROTECTED PERSON (NON-DCO COUNTRY) COUNTRY); REJECTED REFUGEE CLAIMANT TUBERCULOSIS • The cost of the immigration • The cost of the IME. • Consultation fees for the medical examination ( IME). • Consultation fees for the initial assessment and follow- • Consultation fees for initial assessment and follow- ups by a physician or registered the initial assessment and ups by a physician or registered nurse, and cost of required follow-ups by a physician or nurse, and cost of required tests, if patient is not or was registered nurse and cost of tests. required tests. • Cost of testing of close not eligible for provincial/ territorial health insurance. • Cost of testing of close contacts (those who are eligible • Cost of testing of close contacts (those who are for IFHP), to determine if they contacts (those who are eligible eligible for IFHP ), to have tuberculosis. for IFHP), to determine if they determine if they have • Cost of prescribed have tuberculosis. tuberculosis. medication for both the initial • Cost of prescribed • Cost of prescribed patient and close contacts (if medication for both the initial medication for both the initial IFHP eligible), if required. patient and close contacts (if patient and close contacts (if IFHP eligible), if required. IFHP eligible), if required. CARDIOVASCULAR • Consultation fees for • None. • Consultation fees for the DISEASE the initial assessment and initial assessment and follow- follow-ups by a physician or ups by a physician or registered registered nurse, and cost of nurse, and cost of required required tests. tests, if patient is not or was • No coverage for the not eligible for provincial/ prescribed medication. territorial health insurance. • No coverage for the prescribed medication. DIABETES • Consultation fees for • None. • Consultation fees for the the initial assessment and initial assessment and follow- follow-ups by a physician or ups by a physician or registered registered nurse and cost of nurse, and cost of required required tests. tests, if patient is not or was • No coverage for the not eligible for provincial/ prescribed medication. territorial health insurance. • No coverage for the prescribed medication. TOOTH CAVITIES • None. • None. • None. HIV • Consultation fees for • Consultation fees for the • Consultation fees for the the initial assessment and initial assessment and follow- initial assessment and follow- follow-ups by a physician or ups by a physician or registered ups by a physician or registered registered nurse and cost of nurse and cost of required nurse, and cost of required required tests. tests. tests, if patient is not or was • Cost of prescribed • Cost of prescribed not eligible for provincial/ medication. medication . territorial health insurance. • Cost of prescribed medication. the wellesley instit1ute 4 CONDITION REFUGEE CLAIMANT REFUGEE CLAIMANT (DCO PROTECTED PERSON (NON-DCO COUNTRY) COUNTRY); REJECTED REFUGEE CLAIMANT RHEUMATOID • Consultation fees for • None. • Consultation fees for the ARTHRITIS the initial assessment and initial assessment and follow- follow-ups by a physician or ups by a physician or registered registered nurse and cost of nurse, and cost of required required tests. tests, if patient is not or was • No coverage for the not eligible for provincial/ prescribed medication territorial health insurance. • No coverage for the prescribed medication. MENTAL • Cost of most hospital • Cost of most hospital • Cost of most hospital DISORDER WITH services, at the IFHP’s per services at the IFHP’s per diem services, at the IFHP’s per diem PSYCHOTIC diem rate. rate. rate, and cost of ongoing out- SYMPTOMS 10 • Cost of ongoing out-patient • Cost of ongoing out-patient patient follow-up, if patient follow-up by a physician or follow-up. is not or was not eligible for registered nurse. • Cost of prescribed provincial/territorial health • Cost of prescribed medication. insurance. medication. • Cost of prescribed medication. BIRTH CONTROL • None. • None. • None. HIP • Consultation fees for • None. • Consultation fees for the OSTEOARTHRITIS the initial assessment and initial assessment and follow- follow-ups by a physician or ups by a physician or registered registered nurse, and cost of nurse, and cost of required required tests. tests, if patient is not or was • No coverage for the not eligible for provincial/ prescribed medication. territorial health insurance. • No coverage for the hip • No coverage for the replacement surgery. prescribed medication. • No coverage for the hip replacement surgery. PREGNANCY • Consultation fees for • None. • Consultation fees for the the initial assessment and initial assessment and follow- follow-ups by a physician or ups by a physician or registered registered nurse, and cost of nurse, and cost of required required tests. tests, if patient is not or was • No prescribed medication not eligible for provincial/ coverage, unless there are territorial health insurance. complications due to a disease • No prescribed medication that poses a risk to public coverage, unless there are health or a condition of public complications due to a disease safety concern. that poses a risk to public • Cost of delivery in hospital health or a condition of public at the IFHP’s per diem rate. safety concern. • Cost of a post-partum • Cost of delivery in hospital at follow-up for the mother for up the IFHP’s per diem rate. to 28 days after delivery. • Cost of a post-partum follow- up for the mother for up to 28 days after delivery . CONDITION REFUGEE CLAIMANT REFUGEE CLAIMANT (DCO PROTECTED PERSON (NON-DCO COUNTRY) COUNTRY); REJECTED REFUGEE CLAIMANT VISION • Cost of assessment and • None. • Cost of assessment and PROBLEMS diagnosis by a physician. diagnosis by a physician, • Cost of eyeglasses is not if patient is not or was not covered. eligible for provincial/ territorial health insurance. • Cost of eyeglasses is not covered. MEDICAL • Cost of assessment in an • None. • Cost of assessment in an EMERGENCY – emergency room. emergency room, if patient HEART ATTACK • Cost of surgery and most is not or was not eligible for hospital services at the IFHP’s provincial/territorial health per diem rate. insurance. • No coverage for medication • Cost of surgery and most prescribed after discharge. hospital services at the IFHP’s per diem rate.
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