Opinion: Ottawa should pay refugees’ physician and hospital expenses

 

Strain on provincial medical services will be a direct result of federal immigration decisions

 
 
 
 
Charles Shaver believes that Prime Minister Justin Trudeau and Health Minister Dr. Jane Philpott should pledge to take a more active role in co-ordinating and taking over the full payment of physician and hospital care for the new refugees and migrants.
 

Charles Shaver believes that Prime Minister Justin Trudeau and Health Minister Dr. Jane Philpott should pledge to take a more active role in co-ordinating and taking over the full payment of physician and hospital care for the new refugees and migrants.

Photograph by: Chris Procaylo, Chris Procaylo/Winnipeg Sun

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The first wave of Syrian refugees has arrived in Toronto and Montreal. About 220 privately-sponsored refugees may arrive in British Columbia by the end of the year, and another 1,500 refugees during January and February 2016.

Yet Ottawa must revisit the issue of which level of government is paying for their medical and hospital care.

Immigration Minister John McCallum should be commended for his reversal of previous cuts to the Interim Federal Health Program (IFHP). However, this mainly affects privately sponsored refugees and supplemental benefits such as dental and eye care, and prescriptions.

Services rendered by physicians and hospitals will be paid for by the IFHP only until a refugee is covered by provincial health insurance. However, the process will be expedited, and may result in a refugee being “covered” by provincial insurance (as in Ontario) within a few days or weeks of arriving in Canada. Yet this may result in unintended adverse consequences for MDs, hospitals, and the population at large.

Also overlooked in recent months is that during the election campaign, Prime Minister Justin Trudeau promised — under the family reunification program — to double the number of applications allowed for parents and grandparents. He also pledged to shorten the waiting times by doubling the budget for family-class immigration processing. Sponsors were still required to provide private insurance, but only for the first year. After that, these persons would presumably be “covered” by provincial insurance. With a high percentage of immigrants, this issue may prove to be very significant in the Lower Mainland.

Many of these older persons may well require joint replacements or cardiac investigations, angioplasties and even surgery in the next few years. Which level of government will pay?

British Columbia is in the enviable and rather unique position of having a nearly $1 billion surplus. (Ontario is in much worse shape, with a $10.3 billion deficit.) The health budget in B.C. has increased by less than three per cent — largely due to patient-focused health care, savings on laboratory costs, greater use of generic drugs, and bulk purchasing of pharmaceuticals. Nurses and physicians have seen their incomes constrained.

The addition of new demands for service by the refugees and family reunification migrants may result in further cancellation of elective operating room time, and the laying off of more nurses.

This added strain — particularly in large cities such as Vancouver — may act as a tipping point to further reduce overall patient access to timely care as certain clinics close, older physicians retire prematurely, and mobile younger MDs “vote with their feet” and leave their province or even Canada.

Traditionally, health care delivery has been under provincial jurisdiction. While there is ultimately only one taxpayer, it seems much more logical and appropriate for the federal government (with recently a fairly low deficit) to pay physicians and hospitals directly for treating both groups of migrants for the first few years. There are precedents, as Ottawa still pays MDs directly for treating prisoners, and did so until recently for members of the RCMP.

Simply increasing health transfer payments to provincial ministries of health is not a solution, as it is unlikely that hospitals or physicians will ever receive these additional funds in most provinces. When one looks to Ontario, the Canada Health Transfer was increased by six per cent, but the Ontario health budget rose by only 1.2 per cent. Hospital budgets in that province have been frozen for the past four years. Also, the total physician budget has been essentially frozen, regardless of an aging, sicker population with more complex illnesses.

Inasmuch as Ottawa has exclusive control over immigration, Prime Minister Trudeau and Health Minister Dr. Jane Philpott should pledge — before most of these unfortunate persons arrive — to take a more active role in co-ordinating and taking over the full payment of physician and hospital care for the new refugees and migrants.

Ottawa physician Dr. Charles Shaver is chair of the Ontario Medical Association section on general internal medicine.

 
 
 
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Charles Shaver believes that Prime Minister Justin Trudeau and Health Minister Dr. Jane Philpott should pledge to take a more active role in co-ordinating and taking over the full payment of physician and hospital care for the new refugees and migrants.
 

Charles Shaver believes that Prime Minister Justin Trudeau and Health Minister Dr. Jane Philpott should pledge to take a more active role in co-ordinating and taking over the full payment of physician and hospital care for the new refugees and migrants.

Photograph by: Chris Procaylo, Chris Procaylo/Winnipeg Sun

 
 
 
 
 
 
 
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