Healthcare Access for Immigrants and Refugees in Ontario

Everyone is entitled the right to a standard of living adequate for their health and wellbeing(General Assembly of the United Nations, 1948). They include the right to food, clothing, housing, necessary social services and medical care. All children and mothers are entitled to special care and assistance irrespective of where they come from(General Assembly of the United Nations, 1948). Canada is a signatory of the Universal Declaration of Human Rights of the United Nations which makes it compulsory for states to assure accessible medical care to all its residents. Furthermore, medical practitioners have the professional responsibility to administer healthcare to patients without discrimination(Caulford & D'Andrade, 2012). Policy makers are also challenged to ensure that they are adhering to the universal declaration of human rights. Canada has attempted to provide equitable and non-discriminated access to healthcare services, however, there are still other Ontario residents who face challenges while trying to access medical services. Some of the people who meet problems accessing medical care in Ontario are immigrants, refugees, visitors, individuals in the OHIP three month waiting period, foreign workers, people who are undocumented and sponsored persons such as students.

The problem

A recent report by healthcare workers in Scarborough, Ontario, uncovered that a large population of immigrants worked in Ontario but they get denied access to publicly funded healthcare(Caulford & D'Andrade, 2012). Further studies have also revealed that Canada allows large numbers of medical uninsured refugees and immigrants to live across the country which profoundly violates the human right to access healthcare facilities. The estimated number of uninsured people in Canada is between 200,000 and 500,000(Barnes, 2016). The majority of this population is in Toronto as it attracts large numbers of immigrants who are in search of employment. The number is believed to be increasing as days go by as the process and avenues for the attainment of permanent residence are very long and tedious(Barnes, 2016).
Most of the refugees have a hard time completing the whole process due to its complex system. Furthermore, immigrants also face additional obstacles to good health when they get to Ontario, such as; they get low income, few child care subsidies, and underground employment in very poor and deplorable unsafe working conditions. Some immigrants even risk exploitation at work to the extent of them having their wages withheld. Also, they undergo high-stress levels due to settlement issues. The only option they usually have is to purchase private insurance which is very expensive, and most of them can’t afford with their minimum wages.
To add to the financial issues, immigrants also face unique challenges in getting healthcare such as; access health care that is sensitive to their culture. Many immigrants usually come to Ontario with medical conditions that are not detected or diagnosed such as HIV and TB as they are afraid to seek health care due to the costs. Also, some just get denied healthcare when they access medical facilities(Barnes, 2016). Other groups that are vulnerable and uninsured are trafficked women and children into the country and old age individuals who have stayed in the country for long periods of time(Barnes, 2016). Consequently, it is imperative for the government to look into the policy that protects the individual right to access healthcare to consider immigrants, refugees, and other groups affected.

Context

The issue of health access for uninsured individuals cuts across national, political, local, social, cultural and economic backgrounds. The federal government has an essential role of harmonizing all these contexts and make sure that the principal actors and stakeholders contribute to ensuring that the state conforms with the universal declaration with regards to the right to access health care. The country needs to provide the necessary funding to the institutions that provide medical care for the uninsured. The government has previously made efforts to ensure that there are facilities that take care of the uninsured. However, recent reports indicate that the medical facilities are usually under-equipped and the number of uninsured patients has surpasses the available services(Caulford & D'Andrade, 2012).
The political class on their part has to play a significant role in ensuring that the policies that they make provide equal access to health care to all residents of Canada. The politicians also need to look at the plans that grant immigrants and refugees status to become permanent residents of Canada. Immigrants and refugees usually contribute to the growth of the country’s economy(Barnes, 2016). They add a large number of workforce, and an unhealthy working nation is likely to reflect on the economy of the country. Therefore the employer’s communities together with the politicians are required to take care of the foreign workers by providing favorable working conditions and providing health insurance covers for their workers.
The Canadian healthcare system is very complicated to penetrate even at times difficult for its citizens. This unawareness usually prevents both uninsured and insured from accessing medical services(Toronto Medical Officer of Health, 2013). Immigrants may find it difficult to know what to do, and the staff in health facilities is not consistently cognizant of the services available for the uninsured populations. For instance, healthcare practitioners usually have challenges in administering IFHP for refugees(Toronto Medical Officer of Health, 2013). The eligibility criterion for insurance is very complicated, and many service providers and patients cannot decipher who is eligible. As a result, many healthcare providers have become reluctant to treat even qualifying patients(Toronto Medical Officer of Health, 2013).
The Cultural differences also play a role in determining whether the uninsured get access to medical services. For instance, some immigrants and refugees do not usually trust the government or any person whom they perceive as the authority may be due to the past experiences in their home country. As a result, it causes them to shy from seeking health care or even delay and, wish the disease away(Toronto Medical Officer of Health, 2013). On the other hand, some immigrants find the host culture a bit strange to theirs. Therefore, it presents an obstacle for them to receive appropriate healthcare. For example, there are cultures in which women only allow medical practitioners of the same gender to treat them. The situation could pose an added obstacle especially if the condition is an emergency and the medical staffs present are of the opposite sex(Toronto Medical Officer of Health, 2013).
The Society also has a role to play to ensure that the uninsured get access to medical facilities. Most of the times they have been subject to discrimination by the host society, and therefore undocumented residents fear that they might be reported, detained or even deported back. Consequently, it affects their decision making as to whether they should seek medical attention or suffer in silence(Toronto Medical Officer of Health, 2013). The undocumented status has also sometimes led to the harassment of the victims and discrimination by staff in the health facility. Other practitioners even become disrespectful and worse still deny them treatment(Toronto Medical Officer of Health, 2013).

Risks Involved

The influx of refugees into the country through the Ontario gateway means an increase in the number of patients. However according to research by the Spiegel staff on the effects of refugees o the German healthcare system found that the refugees do not significantly stress the resources or the healthcare system of the host country(Spiegel Staff, 2016). The research further explains that the refugees incur approximately half as much as German patients. Relatively this is not very significant as the refugees, in turn, bring economic growth and improvement in the host country’s social welfare. ;The study further adds that immigrants and refugees are healthier than the host country’s population and they refer to this concept as the “healthy immigrant effect(Spiegel Staff, 2016). The people who get to migrate to another country are usually young and healthy individuals. The old, frail, and sick individuals typically remain in their home countries. In another study conducted in the USA confirmed that healthcare costs and hospital use decline when primary health care is made available to the uninsured populations(Caulford & D'Andrade, 2012). Therefore the thought that an influx of refugees means a strain to the local healthcare system is mostly a theory that needs sufficient evidence to support it.

Actors and stakeholders

To ensure equitable access to healthcare, various stakeholders need to play their roles. First, the national government needs to ensure that it provides adequate resources to institutions that have offered to provide health care to an uninsured individual. The federal government also need to ensure that there are policies that explicitly protect the rights of every individual in the country to receive proper health care regardless of whether they are insured or not. The service providers also have a role to play in ensuring that everyone gets access to public healthcare. These service providers such as the insurance company need to come up with tailored policies that are tailor-made so that the refugees can afford.
Health providers also are critical actors in this sector. The health practitioners need to partner with the government and the insurance providers to solve the confusion that exists on whether the Provincial healthcare covers the refugees. Community health centers in Ontario are nonprofit organizations that currently receive funding to provide primary healthcare to uninsured residents(Toronto Medical Officer of Health, 2013). They are the only health care provider that gets funding for specifically uninsured individuals from the Ministry of Health, MOHLTC. The funding can also be used to cover referrals and diagnostic tests. However, this program usually faces challenges with limited funds(Toronto Medical Officer of Health, 2013).
The community has also been a key player in ensuring that the immigrants and refugees gain access to primary health care. There are medical clinics and services in Toronto where showing the health card is not mandatory(Toronto Medical Officer of Health, 2013). These clinics do not receive funding. Consequently, these hospitals can only provide for onsite services but services like diagnostic tests are not covered hence the patients bear these costs. Some facilities also offer to absorb these costs and others usually have a kitty to help these patients pay for their expenses.

Effects of Refugee Health Care Cuts In Canada

Recently there were reforms to the Interim Federal Health (IFH) Program. As a result, the health care providers have faced challenges in providing health care to the refugees and immigrants. First, the framework of coverage is now complicated and often produce administrative difficulties for healthcare providers that can result in denial of healthcare even for persons that have valid IFH cover(Marwah, 2014). Furthermore, the use of emergency rooms has increased, for conditions that could receive treatment at the primary health care level. The requirement to document the designated country of origin list has rendered some class of refugees helpless who have no access to health care services(Marwah, 2014). Also, health care coverage for vulnerable groups such as pregnant women has been reduced to cater only to individuals who pose a public health risk. As a result, it has increased the risk and aggravated complications for the refugee patients(Marwah, 2014).Studies have shown that refugees compared to other groups in Ontario have poor health as a result of the frustrations of displacement and the tiresome resettlement process. The accumulation of these stresses often results in compromised mental and physical state(Marwah, 2014).

Recommendations

Most medically uninsured residents in Ontario do not have access to timely and necessary primary health care(Marwah, 2014). Accessible and convenient primary healthcare contributes highly to healthy birth outcomes and mental health issues. Research has shown that it is cost-effective to provide access to primary health care than to delay until the health conditions have deteriorated(Marwah, 2014). To ensure access to refugee’s immigrants and other uninsured populations, Ontario should include the following recommendations in its healthcare policy.
First, the government needs to reduce the number of the uninsured individuals. The demand for healthcare by the uninsured persons exceeds the facilities that cater to them. Some of the policies that would help in cutting the numbers include; removal of the three month waiting period for OHIP and returning the former IFHP policy that had explicit stipulations on who qualifies to benefit from it. Secondly, Ontario needs to insure the youth and children medically. As a signatory of the UN Convention on the Rights of the Child, children interest becomes a priority whether they are refugees or valid citizens. Also, research has shown that proper health care during early childhood directly projects to good health in adolescents and finally into adulthood(Toronto Medical Officer of Health, 2013). Third, the government needs to ensure that they provide adequate funding to the existing services that provide healthcare for the uninsured. Forth, the persons concerned should draft a policy to contain the medical cost for uninsured patients. The high healthcare cost is a significant obstacle to accessing health care for the refugees. The system could set consistent fees for uninsured patients and also scrap out hospital administration charges. Fifth, the plan should ensure it increases awareness, to the uninsured, of the services that are available for them and how they can access the services. For instance, there could be a central portal that would specifically provide information for the uninsured.

References

Barnes, S. (2016). Healthcare Access for The Uninsured in Ontario.
Toronto: Wellesley Institute. Retrieved November 13, 2017, from http://www.wellesleyinstitute.com/wp-content/uploads/2017/01/Health-Care-Access-for-the-Uninsured-Symposium-Report.pdf
Caulford, P., & D'Andrade, J. (2012, July). Healthcare for Canada’s medically uninsured immigrants and refugees. Canadian Family Physician, 58(7), 725 -727. Retrieved November 13, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395500/
General Assembly of the United Nations. (1948, December 10). Universal Declaration of Human Rights. Retrieved November 13, 2017, from United Nations Website: http://www.un.org/en/universal-declaration-human-rights/index.html
Hilliard, R. (2016, June). Health Insurance for Immigrant and Refugee Families. Retrieved November 13, 2017, from Kids New to Canada Website: https://www.kidsnewtocanada.ca/care/insurance
Marwah, S. (2014). Refugee Health Care Cuts In Canada. Toronto: Wellesley Institute. Retrieved November 14, 2017, from http://www.wellesleyinstitute.com/wp-content/uploads/2014/02/Refugee-Health-Care-Cuts-In-Canada-.pdf
Spiegel Staff. (2016, February 19). What a Million Refugees Mean for Everyday Life. Retrieved November 14, 2017, from Spiegel Website: http://www.spiegel.de/international/germany/22-germans-speak-about-challenges-of-integrating-refugees-a-1075661-8.html
Toronto Medical Officer of Health. (2013). Medically Uninsured Residents in Toronto. Staff Report, Toronto. Retrieved November 13, 2017, from http://www.toronto.ca/legdocs/mmis/2013/hl/bgrd/backgroundfile-57588.pdf