Advertisement

Canadian Journal of Public Health

, Volume 108, Issue 4, pp 435–441 | Cite as

Impacts of the Interim Federal Health Program reforms: A stakeholder analysis of barriers to health care access and provision for refugees

  • Valentina AntonipillaiEmail author
  • Andrea Baumann
  • Andrea Hunter
  • Olive Wahoush
  • Timothy O’Shea
Mixed Research

Abstract

BACKGROUND: Changes to the Interim Federal Health Program (IFHP) in 2012 reduced health care access for refugees and refugee claimants, generating concerns among key stakeholders. In 2014, a new IFHP temporarily reinstated access to some health services; however, little is known about these changes, and more information is needed to map the IFHP’s impact.

OBJECTIVE: This study explores barriers occurring during the time period of the IFHP reforms to health care access and provision for refugees.

METHODS: A stakeholder analysis, using 23 semi-structured interviews, was conducted to obtain insight into stakeholder perceptions of the 2014 reforms, as well as stakeholders’ position and their influence to assess the acceptability of the IFHP changes.

RESULTS: The majority of stakeholders expressed concerns about the 2014 IFHP changes as a result of the continuing barriers posed by the 2012 retrenchments and the emergence of new barriers to health care access and provision for refugees. Key barriers identified included lack of communication and awareness, lack of continuity and comprehensive care, negative political discourse and increased costs. Afew stakeholders supported the reforms as they represented some, but limited, access to health care.

CONCLUSION: Overall, the reforms to the IFHP in 2014 generated barriers to health care access and provision that contributed to confusion among stakeholders, the transfer of refugee health responsibility to provincial authorities and the likelihood of increased health outcome disparities, as refugees and refugee claimants chose to delay seeking health care. The study recommends that policy-makers engage with refugee health stakeholders to formulate a policy that improves health care provision and access for refugee populations.

Key words

Refugees health policy Interim Federal Health Program stakeholder analysis 

Mots Clés

réfugiés politique de santé Programme fédéral de santé intérimaire analyse des acteurs 

Résumé

CONTEXTE : Les modifications apportées en 2012 au Programme fédéral de santé intérimaire (PFSI) ont réduit l’accès des réfugiés et des demandeurs du statut de réfugié aux soins de santé, ce qu’ont déploré les principaux acteurs du milieu. En 2014, un nouveau PFSI a temporairement restauré l’accès à certains services de santé; les rares informations disponibles sur ces modifications sont toutefois insuffisantes pour cartographier l’impact du nouveau PFSI.

OBJECTIF : Notre étude explore les obstacles survenus au cours de la période où des réformes ont été apportées à l’accessibilité et à la prestation des soins de santé aux réfugiés dans le PFSI.

MÉTHODE : Nous avons mené 23 entretiens semi-directifs pour analyser les perceptions des acteurs à l’égard des réformes de 2014, ainsi que la position des acteurs et leur influence sur l’évaluation de l’acceptabilité des modifications au PFSI.

RÉSULTATS : Les acteurs ont majoritairement exprimé des réserves à propos des modifications apportées au PFSI en 2014, en raison de la persistance des obstacles créés par la réduction des dépenses en 2012 et de l’émergence de nouveaux obstacles à l’accessibilité et à la prestation des soins de santé aux réfugiés. Les principaux obstacles qu’ils ont nommés étaient le manque de communication et de sensibilisation, le manque de continuité et d’intégralité des soins, le discours politique négatif et l’accroissement des coûts. Quelques acteurs étaient en faveur des réformes du fait qu’elles offraient un certain accès aux soins de santé, même si cet accès était limité.

CONCLUSION : Globalement, les réformes apportées au PFSI en 2014 ont créé des obstacles à l’accessibilité et à la prestation des soins de santé aux réfugiés, ce qui a contribué à la confusion chez les acteurs, au transfert de la responsabilité de la santé des réfugiés aux autorités provinciales et à la probabilité de creusement des disparités dans les résultats sanitaires, les réfugiés et les demandeurs du statut de réfugié choisissant d’attendre avant d’avoir recours aux soins de santé. L’étude recommande aux responsables des politiques de dialoguer avec les acteurs du milieu de la santé des réfugiés pour formuler une politique qui améliore l’accessibilité et la prestation des soins de santé pour les populations réfugiées.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    United Nations High Commissioner for Refugees [UNHCR]. Global Trends: Forced Displacement in 2015. Geneva, Switzerland: UNHCR, 2016. Available at: http://www.unhcr.org/statistics/unhcrstats/576408cd7/unhcr-global-trends-2015.html (Accessed February 2017).Google Scholar
  2. 2.
    Immigration Refugees and Citizenship Canada [IRCC]. Interim Federal Health Program Policy. 2016. Available at: http://www.cic.gc.ca/english/department/laws-policy/ifhp.asp (Accessed May 2016).Google Scholar
  3. 3.
    Citizenship and Immigration Canada [CIC]. Interim Federal Health Program: Information Handbook for Health-Care-Providers. Edmonton, AB: FAS Benefit Administration Ltd., 2006.Google Scholar
  4. 4.
    CIC. Information Sheet for Interim Federal Health Program Beneficiaries. 2012. Available at: http://publications.gc.ca/collections/collection_2013/cic/Ci44-15-2012-eng.pdf (Accessed January 15, 2016).Google Scholar
  5. 5.
    Government of Canada. Public Works and Government Services Canada: ARCHIVED — Canada Gazette — Order Respecting the Interim Federal Health Program. 2012. Available at: http://www.gazette.gc.ca/rp-pr/p2/2012/2012-04-25/html/si-tr26-eng.html (Accessed July 12, 2015).Google Scholar
  6. 6.
    Canadian Council for Refugees. Refugee Health Care: Impacts of Recent Cuts. Montreal, QC: Canadian Council for Refugees, 2013. Available at: http://ccrweb.ca/sites/ccrweb.ca/files/ifhreporten.pdf (Accessed September 15, 2015).Google Scholar
  7. 7.
    Voices-Voix Coalition. Canadian Doctors for Refugee Care. 2012. Available at: http://voices-voix.ca/en/facts/profile/canadian-doctors-refugee-care (Accessed September 15, 2015).Google Scholar
  8. 8.
    Jones A. Doctors’ group takes Ottawa to court over refugee health-care cuts. The Globe and Mail. 2013. Available at: http://www.theglobeandmail.com/news/politics/doctors-group-takes-ottawa-to-courtover-refugee-health-care-cuts/article9047552/ (Accessed January 15, 2016).Google Scholar
  9. 9.
    Keung N. Canadian doctors, nurses, pharmacists, socialworkers, optometrists and dentists urge Ottawa to rescind planned cuts to refugee health coverage. The Toronto Star. May 23, 2012. Available at: http://www.thestar.com/news/gta/2012/05/23/canadian_doctors_nurses_join_protest_against_cuts_to_refugee_health_plan.html (Accessed January 15, 2016).CrossRefGoogle Scholar
  10. 10.
    Morrison J. Cuts to supplemental health benefits for refugees: Expanding the ai]understanding of patient-centred care. Can Pharm J 2012;145(6):285–86. Available at: http://www.swslhd.nsw.gov.au/refugee/pdf/NSW_REFUGEE_STARTTS.pdf (Accessed September 15, 2015).CrossRefGoogle Scholar
  11. 11.
    Eggertson L. Doctors promise protests along with court challenge to refugee health cuts. Can MedAssocJ 2013;185(7):E275–76 PMID: 23479693.Google Scholar
  12. 12.
    Canadian Doctors for Refugee Care v. Canada (Attorney General), 2014 FC 651 (CanLII). Available at: https://www.canlii.org/en/ca/fct/doc/2014/2014fc651/2014fc651.html (Accessed January 15, 2016).
  13. 13.
    Government of Canada. Immigration, Refugees, and Citizenship Canada: ARCHIVED — Notice — Temporary Measure for the Interim Federal Health Program. 2014.Google Scholar
  14. 14.
    Government of Ontario, Ministry of Health and Long Term Care [MOHLTC]. News Release: Reinstating Access to Health Care for Refugee Claimants. 2013. Available at: https://news.ontario.ca/mohltc/en/2013/12/reinstating-access-to-health-care-for-refugee-claimants.html (Accessed September 15, 2015).Google Scholar
  15. 15.
    Sanders C. Province Steps up for Refugees. Winnipeg, MB: Winnipeg Free Press, 2012. Available at: http://www.winnipegfreepress.com/local/province-steps-up-for-refugees-169590316.html (Accessed January 15, 2016).Google Scholar
  16. 16.
    Howlett M, Ramesh M, Perl A. Studying Public Policy. Toronto, ON: Oxford University Press, 2009.Google Scholar
  17. 17.
    Swinburn B, Gill T, Kumanyika S. Obesity prevention: A proposed framework for translating evidence into action. Obes Rev 2005;6(1):23–33. PMID: 15655036. doi: 10.1111/j.1467-789X.2005.00184.x.CrossRefGoogle Scholar
  18. 18.
    Schiller C, Winters M, Hanson HM, Ashe, MC. A framework for stakeholder identification in concept mapping and health research: A novel process and its application to older adult mobility and the built environment. BMC Public Health 2013;13(1):428. PMID: 23639179. doi: 10.1186/1471-2458-13-428.CrossRefGoogle Scholar
  19. 19.
    United Nations High Commissioner of Refugees. Convention and Protocol Relating to the Status of Refugees. Geneva, Switzerland: UNHCR, 2010.Google Scholar
  20. 20.
    Schmeer K. Guidelines for Conducting a Stakeholder Analysis. Bethesda, MD: Partnerships for Health Reform, Abt Associated Inc., 1999.Google Scholar
  21. 21.
    Immigration, Refugees and Citizenship Canada [IRCC]. Canada — Admissions of Permanent Residents by Intended Province/Territory of Destination and Immigration Category, 2005-January 2016/Admissions de résident permanents selon la province ou le territoire et la catégorie d’immigration, 2005-janvier 2016. Government of Canada, 2016. Available at: http://open.canada.ca/data/en/dataset/036f5d83-490b-491b-a49e-3fed5cc860ad.Google Scholar
  22. 22.
    Mason J. Qualitative Researching, 2nd, ed. Thousand Oaks, CA: SAGE Publications Ltd., 2002.Google Scholar
  23. 23.
    Varvasovszky Z, Brugha R. How to do (or not to do)… A stakeholder analysis. HealthPolicyPlan 2000;15(3):338–45. PMID: 11012410.Google Scholar
  24. 24.
    Greene M. The lived world, literature and education. In: Vandenberg D (Ed.), Phenomenology & Education Discourse. Johannesburg, South Africa: Heinemann, 1997;169–90.Google Scholar
  25. 25.
    Carrillo JE, Carrillo VA, Perez HR, Salas-Lopez D, Natale-Pereira A, Byron, AT. Defining and targeting health care access barriers. J Health Care Poor Underserved 2011;22(2):562–75. PMID: 21551934. doi: 10.1353/hpu.2011.0037.CrossRefGoogle Scholar
  26. 26.
    Torgerson R, Wortsman A, McIntosh T. Towards a broader framework for understanding accessibility in Canadian health care. Ottawa, ON: Canadian Policy Research Networks Incorporated, 2006. Available at: http://cprn3.library.carleton.ca/documents/43661_en.pdf (Accessed September 15, 2015).Google Scholar
  27. 27.
    Nutt P, Backoff R. Strategic Management ofPublic and Third Sector Organizations: A Handbook for Leaders. Francisco, CA: Jossey-Bass, 1992.Google Scholar
  28. 28.
    Ballinger C. Qualitative Research for Allied Health Professionals: Challenging Choices. 2006. Hoboken, NJ: Wiley. Available at: http://site.ebrary.com/lib/alltitles/docDetail.action?docID=10301939 (Accessed September 15, 2015).Google Scholar
  29. 29.
    United Nations High Commissioner for Refugees [UNHCR]. Asylum Levels & Trends in Industrialized Countries. Geneva, Switzerland: UNHCR, 2014. Available at: http://www.unhcr.org/551128679.html (Accessed September 15, 2016).Google Scholar
  30. 30.
    Brugha R, Varvasovszky Z. Stakeholder analysis: A review. Health Policy Plan 2000;15(3):239–46. PMID: 11012397.CrossRefGoogle Scholar
  31. 31.
    Maioni A. Politics and healthcare policy arena in Canada: Diagnosing the situation, evaluating solutions. Paper presented at the Queens’ Health Policy Change Conference Series: Creating Strategic Change in Canadian Healthcare, Toronto, ON, 2014. Available at: http://www.moniesonhealth.com/resources/2014-WhitePaper-Maioni.pdf (Accessed January 15, 2016).Google Scholar
  32. 32.
    IRCC. Determine Your Eligibility — Interim Federal Health Program. Government of Canada, 2016. Available at: http://www.cic.gc.ca/english/refugees/outside/arriving-healthcare/individuals/apply-who.asp (Accessed June 12, 2016).Google Scholar
  33. 33.
    Government of Canada, IRCC. Restoring Fairness to the Interim Federal Health Program [New Releases]. Government of Canada, February 18, 2016. Available at: http://news.gc.ca/web/article-en.do?mthd=tp&crtr.page=1&nid=1034619&crtr. tp1D=1 (AccessedJanuary 15, 2016).Google Scholar

Copyright information

© The Canadian Public Health Association 2017

Authors and Affiliations

  • Valentina Antonipillai
    • 1
    • 2
    Email author
  • Andrea Baumann
    • 2
    • 3
  • Andrea Hunter
    • 4
  • Olive Wahoush
    • 2
    • 3
  • Timothy O’Shea
    • 3
  1. 1.Department of Health Research Methods, Evidence and ImpactHealth Policy PhD Program, McMaster UniversityHamiltonCanada
  2. 2.Global HealthMcMaster UniversityHamiltonCanada
  3. 3.School of NursingMaster UniversityHamiltonCanada
  4. 4.PaediatricsMcMaster UniversityHamiltonCanada

Personalised recommendations