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Health Impacts of Changes to Interim Federal Health. Doug Gruner MD Bruyere Family Health Team University of Ottawa. Crossroads Clinic. Overview. Cuts to the Interim Federal Health Program History of the IFH Program

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Health Impacts of Changes to Interim Federal Health

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Health impacts of changes to interim federal health

Health Impacts of Changes to Interim Federal Health

Doug Gruner MD

Bruyere Family Health Team

University of Ottawa

Crossroads Clinic

Health impacts of changes to interim federal health



Cuts to the Interim Federal Health Program

  • History of the IFH Program

  • Overview of the cuts to the IFHP

  • Consequences of the Health Care Cuts

  • Response from the Medical Community

Historical coverage with ifhp

Historical Coverage with IFHP

  • Provides access to physicians, diagnostics, laboratory testing (as with OHIP)

  • Also provides medication access (identical to the OW formulary) as well as emergency dental and vision care (similar to OW), counselling, prosthetics, long term care, OT/PT

  • Provided to all refugees

  • For urgent and essential care but has been interpreted very broadly

Current changes

Current Changes

  • All refugees (except GAR’s) will lose access to medication formulary, vision, dental, assisted devices

  • For RC’s this may be mitigated by coverage though OW

  • Note copayments; impact on working RC’s

  • Note PSR’s cannot apply for OW

Current changes1

Current Changes

  • Resettled Refugees-

    i) GAR’s-no change in coverage

    ii) PSR’s-loss of “supplementary services”

  • Refugee Claimants

    i) from DCO’s-“public health/security”

    ii) non DCO’s-loss of “supplementary services”

    iii) Rejected Refugee Claimants-public health/security” only

Issues of public health concern

Issues of Public Health Concern

  • “disease posing a risk to public health” means a communicable disease

  • (a) that is on the list of national notifiable diseases of the Public Health Agency of Canada, as amended from time to time,(i) which is subject to human-to-human transmission and requires public health intervention in accordance with provincial legislation, or

    (ii) for which immunization has been recommended under Canadian medical standards; or

Health impacts of changes to interim federal health

  • Acquired Immunodeficiency Syndrome (AIDS)

  • Acute Flaccid Paralysis (AFP)

  • Anthrax

  • Botulism

  • Brucellosis

  • Campylobacteriosis

  • Chlamydia

  • Cholera

  • Clostridium difficile Associated Diarrhea

  • Congenital Rubella Syndrome (CRS)

  • Creutzfeldt-Jakob Disease (CJD), Classic and New Variant

  • Cryptosporidiosis

  • Cyclosporiasis

  • Diphtheria

  • Giardiasis

  • Gonorrhea

  • Group B Streptococcal Disease of the Newborn

  • Hantavirus Pulmonary Syndrome (HPS)

  • Hepatitis A

  • Hepatitis B

  • Hepatitis C

  • Human Immunodeficiency Virus (HIV)

  • Influenza, laboratory-confirmed

  • Invasive Haemophilus influenzae type b (Hib) and non-b Disease

  • Invasive Group A Streptococcal Disease

  • Invasive Listeriosis

  • Invasive Meningococcal Disease

  • Invasive Pneumococcal Disease

  • Legionellosis

  • Leprosy (Hansen's Disease)

  • Lyme Disease

  • Malaria

  • Measles

  • Mumps

  • Norovirus infection

  • Paralytic Shellfish Poisoning

  • Pertussis

  • Plague

  • Poliomyelitis

  • Rabies

  • Rubella

  • Salmonellosis

  • Severe Acute Respiratory Syndrome (SARS)

  • Shigellosis

  • Smallpox

  • Syphilis

  • Tetanus

  • Tuberculosis

  • Tularemia

  • Typhoid

  • Varicella (Chickenpox)

  • Verotoxigenic Escherichia coli Infection

  • Viral Hemorrhagic Fevers

  • West Nile virus Infection

  • Yellow Fever

Issues of public safety concern

Issues of Public Safety Concern

  • “condition of public safety concern” means a mental health condition in a person who has been examined by a physician licensed in Canada and for which the physician is of the opinion that the person will likely cause harm to other


Designated country of origin

Designated Country of Origin

  • People from DCO’s will have limited health coverage even for urgent and essential care

  • Issues of public health or public security will still be covered including medications

  • DCO: Mexico, USA, most of Europe (35 countries)

Rationale for the cuts

Rationale for the Cuts

  • Cost

  • Equity argument

  • Deterrent to refugees

Current situation

Current Situation

Confusion about existing coverage

  • Refugees are less likely to contact health care providers before people decompensate

  • Doctors and hospital administrators are unclear of what the changes mean and are turning refugees away

  • Delay in initiating IFH

  • Failed claimants from Moratorium countries are in a true limbo as far as their health coverage

  • All have lost coverage of “supplementary services”

Response from health care providers

Response from Health Care Providers

  • overwhelming

  • Twenty national health care organizations have publicly opposed the cuts

  • Editorials in medical journals

  • National surveillance system in place

National organizations

National Organizations

  • College of Family Physicians of Canada

  •  Royal College of Physicians and Surgeons of Canada 

  • Canadian Association of Optometrists 

  • Canadian Association of Social Workers

  •  Canadian Dental Association 

  • Canadian Medical Association

  • Canadian Nurses Association 

  • Canadian Pharmacists Association

  •  Canadian Association of Community Health Centres

  • Canadian Doctors for Medicare

  • Canadian Association of Midwives 

  • Registered Nurses Association of Ontario

  • Canadian Federation of Nurses Union

  • Canadian Psychiatric Association

  • Canadian Paediatric Society

  • Association of Medical Microbiology and Infectious Diseases Canada 

  • Médecins du Monde

  • Public Physicians of Canada

  • Ontario’s Council of Medical Officers of Health

  • Canadian Association of Occupational Therapist

Canadian doctors for refugee care

Canadian Doctors for Refugee Care

  • Event at Joe Oliver’s office May 11, 2012

  • National Day of Action-June 2012

  • Press Releases outlining cases

  • Documenting impact of cuts through surveillance system

  • Direct Action events

  • Sharing information with colleagues

Canadian doctors for refugee care where do we go from here

Canadian Doctors for Refugee Care-Where do we go from here

  • Document Cases

  • Lobby provincial govt’s

We need your help


  • Document impact of the cuts (REFUGEE HOMES Tool)

Bill c 31 impact on refugee health

Bill C-31-impact on refugee health

Our position:

-This Bill will negatively impact many facets of refugee health

- Best evidence is around the impact of mandatory detention

Mandatory detention the evidence

Mandatory Detention-The evidence

  • a threefold (in children a tenfold) increase in psychiatric disorder subsequent to detention

  • Higher rates of PTSD, depression and anxiety disorders

  • Related to the duration of detention

Thanks for your attention

Thanks for Your Attention

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