February 7, 2013 by Ceris Ontario
In 2012 the Federal Government of Canada announced changes to the Interim Federal Health Program (IFHP) for the first time in 50 years. This resulted in an unprecedented outcry by health care providers across the country denouncing these changes and drawing attention to concerns about health care for this already vulnerable population. There has been extensive press coverage and writing about these changes to refugee health care – and that is not the focus of this blog. The focus of this blog is to discuss the real life implications of these changes on pregnant women who are refugee claimants.
What it looked like before:
Before the new changes to the IFHP were announced all people who were refugee claimants, including pregnant women, had access to full health care coverage. For pregnant women, this would mean that all lab work including genetic testing, ultrasounds, blood work, physician visits, hospital stays and medications would have been covered.
Results of New IFHP Changes
The changes to refugee health coverage will essentially divide refugee claimants into three categories.
Category 1: GARs
The first category is Government Assisted Refugees (GARS), which are people the Canadian Government assists to enter Canada from refugee camps and other ‘high risk’ regions. For this category of claimants, health care coverage will essentially stay the same and pregnant women falling under this category will still receive full health care coverage – although, it should be noted that only a fraction of refugee claimants in Canada fall under this category.
Category 2: Non-DCO List
The second category will be those women who are from “non-DCO” countries – or refugee claimants who are from countries that are not on the list that the government has deemed “safe”. Pregnant women who are in this category will still receive basic health care coverage but will not have access to medications. For many refugee claimants, who are already living in poverty, the loss of access to medications may have significant impacts on health outcomes.
Category 3: DCO List
The most concerning ‘category’ of women under the new refugee health reforms are the third category – or women from countries that are on the DCO list. The current list of DCO (or “safe”) countries includes mostly European countries and the United States; however it is believed that this list will be considerably increased at a later date. Women from countries on the DCO list will essentially have no health care coverage, except for those conditions that pose a public health risk.
There is a growing body of research focusing on health disparities associated with uninsured populations living in Canada. For a variety of reasons, the population of uninsured and precarious status immigrants in Canada has increased significantly in the last few decades. The result of the recent refugee health changes is a growing number of residents living within our borders without access to adequate health care.
For those who are now ineligible to receive publicly funded healthcare, prenatal care can be costly and difficult. While midwives and Community Health Centers (CHCs) are covered to care for all residents, accessing care through either of these avenues can be difficult as many midwives and CHCs are full to capacity. As a result, many women turn to physicians such as obstetricians for their pregnancy care. Most obstetricians in the Toronto area take a retainer fee before seeing pregnant patients to ensure that the costs of the care they provide will be covered. These retainer fees are generally in the range of $2500-4000. In addition to paying for a practitioner, women without health coverage need to pay for hospital fees. In the Toronto area this cost is generally $1000-2500 per day. Most women stay in the hospital at least 24 hours after delivery, so they are generally paying for two days in the hospital (one day for delivery, one for the postpartum stay). In addition, routine ultrasounds, lab work and genetic testing cost approximately $500. The result is that for a low risk vaginal delivery women are looking at a cost of $5000-9500. A woman who ends up with a high-risk pregnancy can pay 2, 3 or 4 times more. For women who are refugee claimants and often living in poverty, these costs are often simply untenable.
Research has shown that women in Canada without health insurance, such as those living with precarious immigration status — and now refugee claimants on the DCO list – are much less likely to receive adequate prenatal care in their pregnancies. In addition to seeing care providers less often, these women often begin care much later in pregnancy.
Research also shows that comprehensive prenatal care remains one of the most cost effective health interventions. Adequate prenatal care is associated with lower rates of premature infants and low birth weight babies. This is important because both prematurity and low birth weight can result in lifelong health issues – which are amplified for children living in poverty. Costs of care for premature infants remain one of the greatest health expenditures in the Canadian health care system.
This brings us to an important bottom line argument. The Canadian government introduced the changes to the refugee health care program in large part claiming it would save the system money. Health care providers throughout the country have refuted this, voicing concerns that inadequate access to health care only results in people becoming sicker and utilizing the hospital system for more acute problems – which will cost the system more money.
With respect to pregnant women – these changes will result in potentially catastrophic results for themselves, their newborns and the health care system. One sick or premature infant can cost our system tens of thousands of dollars. These infants, once born, are Canadian citizens and will have to be cared for by our health care system.
These changes to our refugee health program will likely result in more Canadian babies that are smaller, sicker and born too early. Aside from the clear human rights concerns that these changes raise, they simply do not make sense from a bottom line cost effective perspective.
About the blog author
Manavi Handa is Assistant Professor in the Midwifery Education Program at Ryerson University. Manavi has been a practicing midwife in Toronto since 2000 and has a graduate degree in Bioethics. She is an Assistant Professor at Ryerson University and is the Chair of the Diversity Working Group for the Association of Ontario Midwives. As a midwife and activist, Manavi has focused on serving immigrant and marginalized women. In recognition of her contribution to immigrant women’s health, she received the prestige “Urban Alliance for Race Relations” award in 2010. Manavi is a founding partner at West End Midwives and has been Head Midwife at both St. Joseph’s Health Centre and Etobicoke General Hospital in Toronto.