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

Abstract

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.

Access to health care among racialised immigrants to Canada in later life: a theoretical and empirical synthesis

“…A health records review indicated that such Canadian Refugee Health Policy Reforms had decreased access to regular family doctors and created barriers to emergency care ( e.g. higher rate of rejected claims) for refugee patients (Bakewell et al , 2018). This financial cutback may further intensify clinicians’ bias and prejudice towards refugees as ‘demanding’ patients (Spitzer, 2004; McKeary and Newbold, 2010), due to refugees’ increasingly stringent insurance and burdensome paperwork (Edge and Newbold, 2013).…”

Refugee health care funding in Canada

“…6 In fact, the admission rates for refugee children at Sick Kids Hospital in Toronto nearly doubled. 7,8 As a result of their ethical responsibilities to treat patients in emergencies, many public hospitals across the country absorbed the costs of providing care for uninsured refugee themselves. 10 The University Health Network in Toronto, for instance, reported an unpaid service debt totalling greater than Can$800 000 for uninsured emergency services alone due to the IFHP reforms.…”