Refugees Deserve Health Care. They Shouldn’t Have to Pay

The federal government’s recent decision to introduce co-payments for medications and supplemental services — including mental health, and preventative vision and dental care — under the Interim Federal Health Program, or IFHP, is not only harmful to refugees and asylum seekers, it is also poor health policy.

These changes will predictably reduce access to essential care, worsen health outcomes and increase pressure on already overwhelmed emergency departments and hospitals. They will ultimately increase public health-care costs.

The government has framed the changes to the Interim Federal Health Program as a modest way to reduce costs by asking patients to “contribute a little” so that spending will fall. Some commentary has argued that introducing co-payments for refugee health benefits reflects fiscal restraint and fairness.

These are familiar, yet faulty, arguments. Decades of international evidence suggests the opposite, particularly when co-payments are imposed on people with limited incomes and complex health needs.

For refugees, essential care is critical. And shouldn’t come with a price tag.

Consider that refugees and refugee claimants arrive in Canada after fleeing war, persecution, torture, or prolonged displacement. They can arrive with health needs, such as untreated chronic disease, war-induced injuries or trauma-related mental health concerns, reflecting years of disrupted care.

During their first year in Canada, resettled refugees are not yet eligible for provincial drug plans or income supports, and most face major barriers to employment.

For refugee claimants, Interim Federal Health Program coverage is valid until a claim is accepted and they transition to provincial health coverage.

The Interim Federal Health Program exists precisely because, without it, essential care would be inaccessible during this critical transition period.

Introducing co-payments at this moment erects a barrier when people are medically vulnerable, financially unstable, under acute mental stress and trying to rebuild their lives.

Access to timely care helps refugees get on their feet, supporting their longer-term integration and economic success.

Many high-quality studies have shown that cost-sharing or even nominal co-payments are associated with increased inpatient and acute care use, thereby increasing overall health-care use and costs.

Whereas a recent randomized trial from New Zealand showed that removing a modest $5 prescription charge for high-need, socioeconomically deprived patients led to fewer hospitalizations overall.

These effects are not theoretical. As service providers, we see them play out in real time. An unfilled blood pressure medication that costs the government pennies per day can lead to tens of thousands of dollars in hospital costs treating a stroke.

This is the result when policy ignores evidence.

Downloading costs to provinces and territories

There is another contradiction to consider. While the federal government may reduce a budget line item by introducing Interim Federal Health Program co-payments for medications and essential therapies, the resulting higher hospital use and disability costs simply download more expensive care onto the health budgets of provinces and territories.

An argument frequently cited in support of the government’s changes is that the number of people accessing the Interim Federal Health Program has increased significantly.

The primary driver of rising Interim Federal Health Program expenditures is not overuse of care but prolonged delays in refugee claim processing. Backlogs at the Immigration and Refugee Board mean that individuals remain in legal and social limbo, requiring extended Interim Federal Health Program coverage.

The federal government says it has a broader aim of ensuring fiscal responsibility. To do so, the evidence is clear: invest in timely primary care, uninterrupted access to essential medications, and early treatment of chronic and mental health conditions.

While the United States dismantles its refugee resettlement system and terrorizes migrant communities, Canada must not adopt policies that undermine the health and social and economic participation of refugees here.

Introducing co-payments for people seeking safety in Canada is not prudent stewardship and one we already know better than to repeat.

In 2012, refugee health cuts were rationalized using similar language about cost containment and deterrence. They resulted in preventable harm, increased system strain and a Federal Court ruling that found the policy to be “cruel and unusual treatment,” a violation of Canada’s Charter of Rights and Freedoms. Those cuts were ultimately reversed by the government.

Most refugees become Canadian citizens, contributing to the workforce and society for decades.

Undermining health soon after arrival creates avoidable costs and harms that compound over a lifetime.

The introduction of co-payments will cost more — in human health and in system expenditures — than it saves. If the government is serious about fiscal responsibility, it should follow the evidence and reverse this penny-wise and pound-foolish decision.