Healthcare is political: case example of physician advocacy in response to the cuts to refugees’ and claimants’ healthcare coverage under the Interim Federal Health Program

Abstract

INTRODUCTION “Healthcare is political.” That phrase seems obvious. While healthcare is constitutionally a provincial responsibility, it has become a hallmark of Canadian federalism with all levels of government taking part in its function. Furthermore, it has become one of the core Canadian values, with Canadians continuing to place healthcare as the strongest symbol of their national identity. Yet, as future physicians, medical students are wary of “getting political” in fear of taking sides, loosing impartiality, and losing focus on patient care. However, political actions and issues can have a significant impact on the clinical practices of all physicians. This article will argue that changes to the Interim Federal Health Program (IFHP) have hindered the ability of physicians to provide best practice, evidence-based medicine, and will outline how members of the medical profession, including University of Ottawa medical students, have played an important role in advocating for those affected by the changes to the IFHP. In April of 2012 the federal government announced changes to the IFHP, a health insurance program developed in 1957, intended to provide temporary coverage to refugees, refugee claimants, and protected persons who are not covered by provincial or territorial health insurance plans. Prior to June 2012, the IFHP covered medical care, diagnostics and laboratory testing similar to that covered by provincial health plans. The IFHP also covered medications, emergency dental and vision, similar to what is available to people on provincial social assistance plans [1]. The changes announced in 2012 created different tiers of coverage for eligible individuals based on their refugee status in Canada. Most refugees (those found by the Government of Canada to be refugees or persons in need of Canada’s protection following an examination of their case) and refugee claimants (those awaiting a decision on their case in Canada) lost supplemental coverage for prescription medication, vision and dental care. Refugee claimants from countries designated by the Government of Canada to not normally produce refugees and failed claimants [2], and those whose cases are determined to not fit the definition of a refugee, retained coverage only for issues posing a risk to public health and safety [3]. The reduction in coverage is resulting in negative health outcomes for refugees and claimants, while also making it difficult for health practitioners to follow best practices and provide evidence-based care. The following case study describes a hypothetical case that illustrates the challenges facing individuals and practitioners affected by the changes to the IFHP.