The Cost and Impact of the Interim Federal Health Program Cuts on Child Refugees in Canada

Evans, Andrea; Caudarella, Alexander; Ratnapalan, Savithiri; Chan, Kevin

doi:10.1371/journal.pone.0096902

Cited by 18 publications

(20 citation statements)

References 8 publications

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“…This confusion may lead to refusal of services to individuals with valid IFH coverage, requesting payment for services to which they are entitled or discouraging clinicians from providing services. Indirect negative consequences are also to be expected as refusal of care and demands of fees may deter refugee claimants from seeking health care in the future [ 9 , 17 ]. Poor knowledge uptake concerning the IFH program may be linked to an overly complex program, poorly designed implementation procedures, inadequate dissemination of information, and/or the target audience’s lack of interest (for example, busy physicians who experience difficulties being reimbursed may choose to refuse IFH patients rather than seeking additional information)[ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Knowledge of Healthcare Coverage for Refugee Claimants: Results from a Survey of Health Service Providers in Montreal

Ruiz‐Casares

Cleveland

Oulhote³

et al. 2016

PLoS ONE

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Following changes to the Interim Federal Health (IFH) program in Canada in 2012, this study investigates health service providers’ knowledge of the healthcare coverage for refugee claimants living in Quebec. An online questionnaire was completed by 1,772 staff and physicians from five hospitals and two primary care centres in Montreal. Low levels of knowledge and significant associations between knowledge and occupational group, age, and contact with refugees were documented. Social workers, respondents aged 40–49 years, and those who reported previous contact with refugee claimants seeking healthcare were significantly more likely to have 2 or more correct responses. Rapid and multiple changes to the complex IFH policy have generated a high level of confusion among healthcare providers. Simplification of the system and a knowledge transfer strategy aimed at improving healthcare delivery for IFH patients are urgently needed, proposing easy avenues to access rapidly updated information and emphasizing ethical and clinical issues.

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Section: Discussionmentioning

confidence: 99%

Knowledge of Healthcare Coverage for Refugee Claimants: Results from a Survey of Health Service Providers in Montreal

Ruiz‐Casares

Cleveland

Oulhote³

et al. 2016

PLoS ONE

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“…This study describes the impact of the 2012 cuts to the IFH program on ED use by adult refugee claimants. Evans et al published a similar study in 2014 on the impact of the cuts on claims made in the pediatric ED at the Hospital for Sick Children in Toronto [ 15 ]. Similar to our study, they found that the IFH program cuts, reduced the number of claims and increased rejected claims.…”

Section: Discussionmentioning

confidence: 99%

Use of the emergency department by refugees under the Interim Federal Health Program: A health records review

et al. 2018

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IntroductionIn June 2012, the federal government made cuts to the Interim Federal Health (IFH) Program that reduced or eliminated health insurance for refugee claimants in Canada. The purpose of this study was to examine the effect of the cuts on emergency department (ED) use among patients claiming IFH benefits.MethodsWe conducted a health records review at two tertiary care EDs in Ottawa. We reviewed all ED visits where an IFH claim was made at triage, for 18 months before and 18 months after the changes to the program on June 30, 2012 (2011–2013). Claims made before and after the cuts were compared in terms of basic demographics, chief presenting complaints, acuity, diagnosis, presence of primary care, and financial status of the claim. Bivariate or multivariate logistic regression analysis was performed to yield odds ratios (OR) with 95% confidence intervals.ResultsThere were a total of 612 IFH claims made in the ED from 2011–2013. The demographic characteristics, acuity of presentation and discharge diagnoses were similar during both the before and after periods. Overall, 28.6% fewer claims were made under the IFH program after the cuts. Of the claims made, significantly more were rejected after the cuts than before (13.7% after vs. 3.9% before, adjusted OR 4.28, 95% CI: 2.18–8.40; p<0.05). The majority (75.0%) of rejected claims have not been paid by patients. Fewer patients after the cuts indicated that they had a family physician (20.4% after vs. 30% before, unadjusted OR 1.67, 95% CI: 1.14–2.44; p<0.05) yet a higher proportion of patients without a family physician were still advised to follow up with their family doctor during the after period (67.2% after vs. 41.8% before, unadjusted OR 2.85, 95% CI: 1.45–5.62; p<0.05).ConclusionA higher proportion of both rejected and subsequently unpaid claims after the IFH cuts in June 2012, as demonstrated in the logistic regression analysis in this health records review, represents a potential barrier to emergency medical care, as well as a new financial burden to be shouldered by patients and hospitals. A reduction in IFH claims in the ED and a reduction in the number of patients with access to a family physician also suggests inadequate primary care for this population, yet this was not reflected in the follow-up advice offered by ED physicians to patients.

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“…A one-year retrospective chart review study examining emergency room visits at the Hospital for Sick Children in Toronto six months before and six months following the IFHP cuts determined that the hospital was unable to obtain federal health coverage for the vast majority of refugee claimant children registered under the IFHP, and that the costs were absorbed by the hospital (Evans et al 2014). The question of how the reforms impacted Canadian politics is as yet unstudied.…”

Section: Discussionmentioning

confidence: 99%

Reducing Health Services for Refugees Through Reforms to the Interim Federal Health Program

Stevenson

2018

HRO-ORS

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The Cost and Impact of the Interim Federal Health Program Cuts on Child Refugees in Canada

Cited by 18 publications

References 8 publications

Knowledge of Healthcare Coverage for Refugee Claimants: Results from a Survey of Health Service Providers in Montreal

Knowledge of Healthcare Coverage for Refugee Claimants: Results from a Survey of Health Service Providers in Montreal

Use of the emergency department by refugees under the Interim Federal Health Program: A health records review

Reducing Health Services for Refugees Through Reforms to the Interim Federal Health Program

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