Social Policy in Ontario

For Canadians fighting to reverse the elimination of health-care coverage for refugees, it is a matter of human decency. Withholding life-saving drugs and doctors’ services from asylum seekers is medically and morally wrong.

For the federal Conservatives, it is a matter of money. “In 2013 alone, thanks to our reforms, asylum claims from safe countries dropped by a whopping 87 per cent — saving taxpayers $600 million in spending,” Immigration Minister Chris Alexander wrote in the Star, taking issue with his critics. “Visitors to Canada do not enjoy access to OHIP. Economic immigrants only get it after three months. We believe pre-hearing and failed claimants do not deserve it either.”

There is a middle ground.

Sonal Marwah, who is completing a master’s degree in global health at McMaster University, explores it in a study released this week by the Wellesley Institute. She does not make value judgments. She does not use emotional language. She sticks to known facts, documented cases and evidence she collected in interviews with health-care providers, directors of clinics and community agencies, and refugee workers.

One of her most surprising findings is that Ottawa’s cutbacks have exposed Canadians to health risks the government did not anticipate and has not acknowledged. Infectious diseases, wiped out long ago in this country, could make a comeback if refugees are left untreated. Although the legislation allows medical professionals to immunize asylum seekers with communicable diseases, it does not permit them to use publicly-funded lab tests to diagnose unfamiliar symptoms. Without accurate information, the probability of mistakes goes up.

Her second unsettling discovery is that the cost of cutting off access to health care could quickly overtake the savings. Bill C-31 prevents doctors from treating diseases in their early stages when they can be cured or managed. This heightens the risk a refugee will be hospitalized with a full-blown case of a serious disease, a life-threatening tumour or infected limb that cannot be saved. Most emergency wards don’t turn away uninsured patients. But the provinces have to pay their bills.

Her third eye-opener is that pregnant women in refugee limbo are giving birth at home — often with heartbreaking consequences — because they can’t pay $2,600 for a hospital delivery. In many cases, they’ve had no prenatal care because obstetricians demanded upfront payment for a consultation. Their babies — Canadian citizens by birth — are often premature, underdeveloped, with neurological problems and other complications. These struggling infants cost medicare much more than proper screening and prenatal care would have done.

Her fourth finding, foreshadowed by Canadian Doctors for Refugee Care, is that some walk-in clinics, specialists and general practitioners have adopted a blanket policy of turning away refugees — even those who qualify for coverage under Ottawa’s complicated rules — rather than sorting out their immigration status. Under Ottawa’s plan, approved refugees, government-assisted refugees and privately sponsored refugees are eligible for health benefits. Rejected claimants and asylum seekers from countries Ottawa deems safe are not. Unwilling to navigate this labyrinth, some medical practitioners deny treatment to all refugees.

Six provinces — Alberta, Manitoba, Saskatchewan, Ontario, Quebec and Nova Scotia — have stepped into the breach. But their levels of assistance vary. Only Quebec provides full medical, diagnostic and hospital coverage to all asylum seekers. Ontario provides primary care and urgent hospital services to refugees denied health care by Ottawa. But it imposes a three-month wait. Other provinces have similar restrictions.

Some doctors and nurse practitioners treat refugee claimants pro bono. Many community health centres and midwife clinics turn a blind eye to a migrant’s legal status. And a few municipalities, including Toronto, have declared themselves “sanctuary cities” allowing refugees access to all social services.

These efforts have filled critical gaps, Marwah reported. But what has emerged is an inequitable patchwork that frustrates health-care providers, confuses refugees and deters them from seeking badly-needed medical help.

The ideal solution would be a rethink of the federal cuts, she concludes. The next best alternative would be for all provinces to follow Quebec’s lead, extending comprehensive coverage to refugees. In the absence of government action, she recommends more teamwork among front-line workers.

Marwah does not moralize or condemn. She simply points out that eliminating medical care for “undeserving” refugees will hurt people far beyond its intended targets, increase the risk of infectious disease outbreaks and dump Ottawa’s responsibilities on the provinces and volunteers.

< http://www.thestar.com/opinion/commentary/2014/02/27/cutting_refugee_health_care_a_false_saving_goar.html >