Roma Centre of Toronto settlement worker Gyongyi Hamori and Margit Balogh in front of a poster documenting the history of attacks on Roma in Eastern Europe. Photo by Michael Swan

Federal medical cuts for refugees more costly in long run

By 
  • May 25, 2012

Agnes Raduly discovered she was diabetic after she arrived in Canada five months ago. She’s one of thousands of Roma from Hungary and the Czech Republic in Canada claiming refugee status, living on less than $1,000 a month, struggling with a new language and a vastly foreign culture.

In mid-May she got a letter from Citizenship and Immigration Canada telling her that her medication for diabetes won’t be covered by the federal government’s health plan starting July 1. The two pills in the morning and two in the evening are more than she can possibly afford, she said.

“It will be very bad. I don’t know how I can solve it,” said Raduly, staring at the floor.

Margit Balogh got the same letter.

“I just had to stop and had to think, ‘No, it’s not possible. They can’t do it. So many people could die,’ ” she said through an interpreter.

With high blood pressure, high cholesterol and a developing case of osteoporosis, a complete loss of pharmaceutical benefits is unthinkable for her and her son living on $938 per month.

It’s very possible that Immigration Canada’s newly issued order in council limiting health coverage to all classes of refugees will result in death, said Dr. Tatania Friere-Lizama, a perinatologist at Toronto’s St. Michael’s Hospital who came to Canada with her family as a refugee at the age of seven.

“If you’re talking about a situation where someone with diabetes doesn’t have enough money to pay for their insulin, that’s life-threatening,” she said. “You’re talking about a situation here, having somebody in an intensive care unit being treated for a diabetic coma because they were no longer able to buy their insulin. That’s a whole lot more expensive than just providing them with primary care and their medications.”

Refugees currently receive full medical, pharmaceutical, dental and vision coverage while their case is being processed. As of July 1, benefits will be reduced for all classes of refugees, more or less depending on their country of origin and how they arrived in Canada. Full coverage will be restored eventually only to those who become landed immigrants.

Dr. Philip Berger, St. Michael’s Hospital chief of family medicine, was stunned when he read that for one class of refugees the new federal government health insurance plan won’t even cover a heart attack.

“It says ‘Medical emergencies; category, heart attack; coverage, none,’ ” said Berger.

“None!” he screams over the phone. “I’ve never seen a government document ever that actually says none. It’s the same with pregnant women — coverage, none.”

Refugees not covered for a heart attack or for delivering a baby in a hospital are those whose initial application for refugee status have been rejected by the Immigration and Refugee Board, or those who come from a list of yet-to-be-revealed “Designated Countries of Origin.” The DCO countries will be those the government judges safe, democratic and non-refugee producing.

But even refugees whom the government itself plucked out of refugee camps will lose basic coverage for drugs, visits to the dentist, ambulance rides, wheelchairs and glasses — exactly the kind of care they would have received from the United Nations High Commission for Refugees and allied NGOs in a refugee camp.

The more restrictive health coverage for refugees is necessary “to ensure that IFHP (Interim Federal Health Program) beneficiaries do not receive benefits that are more generous than those provided to Canadians through government-funded benefit programs,” according to an e-mail from the Citizenship and Immigration Canada media department.

Agnes Raduly with Roma Centre of Toronto settlement worker Gyongyi Hamori. Agnes received a letter telling her that her medication for diabetes won’t be covered by the federal government’s health plan starting July 1.

Agnes Raduly with Roma Centre of Toronto settlement worker Gyongyi Hamori. Agnes received a letter telling her that her medication for diabetes won’t be covered by the federal government’s health plan starting July 1.

Photo by Michael Swan

But refugees aren’t getting special treatment, only the same health coverage vulnerable people dependent on Old Age Security or welfare would receive, said Office of Refugees, Archdiocese of Toronto executive director Martin Mark.

“It’s not true that these people get better health insurance than a Canadian. A Canadian in a similar situation, like a person on welfare, gets nearly the same,” he said.

New restrictions on health coverage are bound to cost the 160-plus Toronto-area parishes with active refugee sponsorship committees, said Mark. Parishes will end up footing the bill when Citizenship and Immigration withdraws drug, dental and vision coverage.

“Once you get families or individuals in high need, then that parish, that (refugee sponsorship) committee will be really, really devastated,” Mark said.

“It was really unfortunate that they tried to use this legislation to kind of pit Canadians against refugees,” said Dr. Fok-Han Leung, the physician lead at St. Michael’s Hospital’s 80 Bond Street Health Centre. “They billed it as such by saying they’re getting all this and regular Canadians are not.”

In an e-mail to The Catholic Register the CIC media department claims, “It is unfair to ask Canadians to fund benefits for protected persons and refugee claimants that they are not necessarily entitled to themselves.”

But that doesn’t cut it for Leung.

“I believe most Canadians would be interested in what is ‘just’ over what is ‘fair,’ ” said Leung.

Leung, Berger and Friere-Lizama were among 90 doctors who showed up at Federal Natural Resources Minister Joe Oliver’s Toronto office May 11 to protest the cuts. A similar rally of doctors was held on Parliament Hill.

“If one sees what is a gross injustice, and a plan that violates basic Canadian values of fairness and compassion — and I would say Catholic values as well — then doctors have a duty to speak out,” said Berger.

The CIC media department claims the cuts have been misunderstood.

“The program has expanded beyond its original intent, in terms of both benefits covered and people eligible,” they said.

CIC claims the new restrictions will save the government $100 million over five years.

Cutting preventative care and maintenance is actually going to cost taxpayers more in the long run, said Friere-Lizama.

“Anybody who works in health knows primary care is much cheaper than urgent health care. If you wait until health conditions deteriorate, until people need urgent care, it’s a whole lot more expensive,” she said.

The information given to physicians is riddled with restrictions that violate good medical practice, said Leung.

“Someone treated in the ER for a heart attack would get all the emergency medications,” he notes. “But the cholesterol lowering medication post-heart attack would not be covered. This dramatically raises their risk of repeat heart attack.”

Cutting prenatal care to pregnant refugee women will have dire consequences, said Friere-Lizama. “We know that we decrease maternal and newborn mortality by providing prenatal care. Women in those groups who are going to be denied even access to prenatal care — that’s a disaster waiting to happen,” she said.

Women under stress, facing difficult pregnancies have shown up in Friere-Lizama’s office crying since they received the CIC letter.

“I don’t know what to tell them,” said the doctor.

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