Refugees and the Interim Federal Health Program

Abdihamid Abdihalim considers the benefits and challenges of Canada’s Interim Federal Health Program.

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The ongoing Syrian conflict has created the world’s largest humanitarian crisis since the Second World War. Since the start of the conflict, millions of Syrian citizens have been forcibly displaced, including over 4 million refugees. Canada has taken positive steps to address this crisis, including sponsoring over 25,000 Syrian refugees to migrate to Canada. Many of these refugees have had traumatic experiences, including exposure to violence and war. For some of these refugees these experiences have  lead to substantial physical and mental health concerns that need to be addressed.

The Interim Federal Health Program, established in 1957, provides temporary health insurance to specific groups that are not eligible for provincial or territorial health insurance. For example, this Federal Program covers government and privately sponsored refugees, refugee claimants, and rejected refugee claimants. These groups also receive temporary supplements to their healthcare benefits (for example, dental care and certain prescription medications) for one year after obtaining provincial or territorial insurance.

Migrating to a new country can be a difficult and stressful transition. Unlike traditional immigrants who want to settle in a different country to pursue specific life goals and objectives (for example, employment), refugees move to a new country to escape violence, war or persecution. As a result, their integration into Canadian society can be more challenging than for other newcomers. Access to healthcare is of particular importance for refugees because they frequently arrive with significant and often neglected health concerns. For this reason, the Federal Program is critical for refugees.

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There are several benefits with the Federal Program, including the provision of immediate healthcare coverage so refugees do not remain without health insurance before they obtain provincial/territorial insurance.  The coverage provided is similar to that provided to low-income Canadians. However, while the Federal Program is great in theory, in practice, the implementation of this program is complicated and raises a number of challenges.

The Federal Program is complicated, in part, because it is under the control of the Federal government of the day and subject to revision. For example, in 2012 and again in 2014, the Conservative federal government made changes to the Federal Program that effectively eliminated healthcare insurance for some refugees and reduced insurance for many others. It also created different categories of beneficiaries – dividing up the refugee population into different groups. This manufactured complexity lead to confusion on the part of healthcare professionals regarding the extent of coverage for their refugee patients. For example, many healthcare providers were unsure about which services could be reimbursed. As a result, some providers charged refugee patients for services they were entitled to. Other providers simply refused to take on refugee patients.

Essentially, the 2012 and 2014 changes to the Federal Program created numerous challenges. First, the federal government significantly decreased program funding. Second, there was the increased complexity of the program as a result of the changes made to the funding scheme in 2012 and again in 2014. Third, there was increased confusion resulting from the complexity and changes to the program. Last, the registration and reimbursement processes were made more burdensome for refugees and health care providers.

In 2016, the newly elected Liberal federal government made some changes to the Federal Program to begin to address these challenges. The government returned the Federal Program to its pre-2012 capacity, restoring it’s funding, eliminating the categorization of refugees, and also expanding certain provisions. With these measures in place the federal government is now well placed to take further steps to address remaining challenges. These challenges include the continued confusion surrounding the Federal Program and the excessive burden it continues to place on health care providers who service patients insured under the program.

I suggest that the federal government work with provincial and national medical associations to create an awareness campaign about what the Federal Program entails, how it can be accessed, who is covered and to what extent they are covered. The government should also work to simplify the Federal Program’s registration and reimbursement processes to reduce the burdens on healthcare providers who are trying to take on refugee patients.

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Abdihamid Abdihalim is a Medical Student at Dalhousie University, Class of 2019.