Refugee health cuts causing confusion, say Hamilton health workers

Sue Grafe and Nikki Bozinoff have a first-hand look at how last year’s changes to the federal health care program affect refugee health care in Hamilton.

Grafe is a nurse practitioner at REFUGE, a Hamilton refugee clinic, as well as a nursing professor at Mac. Bozinoff is a McMaster medical student and member of Hamiltonians for Migrant and Refugee Health.

Along with Mac economics professor Michel Grignon, they discussed the impact of last year’s refugee health cuts Tuesday at a panel hosted by the Global Citizenship Conference.

Cuts to the Interim Federal Health Program (IFHP) were brought into effect on June 30, 2012, intended to minimize abuse of health privileges. As of then, refugees not assisted by the government have no vision, dental or medical coverage except in emergencies. Refugees from a “designated country of origin” don’t get any coverage.

At the panel, Grafe and Bozinoff said since the cuts were implemented, there has been a great deal of confusion among practitioners about who has coverage and who doesn’t.

“We [at REFUGE] see people regardless of coverage, but the problem becomes, what do you do?” said Grafe.

“There are pregnant clients who don’t get prenatal care because they fall within the gap of having and not having coverage.”

Bozinoff added that there were problems with IFPH even before the cuts were made.

“Even before the cuts, many [refugees] were turned away if they didn’t have a knowledgeable providers,” she said.

Grafe said that prior to the cuts, many Hamilton refugees had been using walk-ins, but because of the confusion, they seem to be using those services less.

She anticipates that refugees from Hungary, Slovakia and the Czech Republic are most affected by the cuts in Hamilton, recognizing that refugees from various countries tend to settle differently across cities.

Grafe also observed some “ironic” inconsistencies in the system with changes to the IFHP.

In some cases, she said, “you can get their medication covered if they qualify for Ontario Works, but you can’t run any blood work.”

In getting coverage through Ontario, she and Bozinoff pointed out, the health care costs are downloaded to the Province.

According to Citizenship and Immigration Canada, the IFHP costs $84 million per year, and the cuts would save $20 million annually to a total of $100 million after five years.

Michel Grignon, director of the Centre for Health Economics and Policy Analysis, approached the issue from a socio-economic perspective.

On whether or not Canada’s international image would be negatively affected by the cuts, Grignon doesn’t think so.

“We’re still doing reasonably well in terms of [the numbers] of refugees who come here—we are still seen as fairly generous.”

Currently, Canada is home to 5 refugees per 1000 people. The US has a ratio of 0.9 per 1000 while Syria has 49 per 1000.

He did express some qualms about the policy moving Canadian healthcare toward a two-tiered system.

“What’s great about universal coverage is that doctors don’t have to worry about who is covered. In the UK nobody will ask you anything, they just treat you,” said Grignon.