The federal government overhauled the health care coverage it provides to refugees and refugee claimants one year ago as part of a cost-cutting measure it also said was designed to make Canada less vulnerable to fake asylum claims by curbing access to free health care.
But the changes have thrown the health care support system for refugees into chaos, creating uncertainty for health care providers and refugees alike, advocates said.
The result has been a patchwork approach to treating refugees and refugee claimants that's hurting some of the most vulnerable people in Canada, said Dr. Doug Gruner of Canadian Doctors for Refugee Care.
"If they've got a cough, it could be tuberculosis but we're never going to know because they're not going to the doctor," Gruner said Monday.
"But they are going to the playgrounds, the schoolyards and the shopping centres, putting the rest of us at risk."
Until the changes to the interim health care program last year, all refugees and refugee claimants received the same amount of supplemental health care coverage from the federal government.
The program was meant to bridge the gap between a refugee's arrival in Canada and their ability to qualify for provincial coverage, including for items such as dental, vision and drug costs.
In 2006-2007, coverage cost taxpayers $48.3 million, but in 2011-2012 those costs grew to $82.9 million as the number of refugee claims soared, statistics provided Monday by Citizenship and Immigration show.
Now, coverage is determined by criteria such as where claimants are from and whether their claim is pending, accepted or rejected.
For example, those seeking asylum from one of 37 countries considered safe by the federal government have coverage that's limited to situations that pose a risk to public health or conditions that are of a public safety concern.
Those applying from other countries also have their benefits limited to services deemed essential or urgent.
In both cases, if applications are accepted, claimants receive limited extra benefits — but only for situations that pose a risk to public health or conditions that constitute a public safety concern.
That means many refugees are left without coverage for dental or vision care, and no access to prescription drugs until their provincial benefits kick in.
"This is a bad policy. This is bad for the health of refugees, this is bad for the health of Canadians for our own public health and this is bad for the taxpayer," said Gruner.
"This will cost taxpayers dramatically more money."
The changes were billed as saving the government $100 million over five years, but the department said Monday it couldn't provide figures yet for how much was saved in 2012-2013; health care providers have six months to submit claims.
But there have been obvious impacts, said Gruner.
In Ottawa alone, there used to be more than 30 clinics that would accept refugee patients. Only nine remain, and they require payment up front, he said — a cost often beyond the means of refugees.
"This is not the way Canadians would imagine welcoming some of its newest citizens and arguably some of the most vulnerable to our society by preventing them from accessing health care," Gruner said.
Rather than seeking primary care, refugees are showing up at emergency rooms, which adds to the burden of provincial medical systems and costs taxpayers even more, he added.
While he couldn't provide exact statistics, Gruner said research continues to document the effect of program changes on hospitals and refugee populations.
The government has no heart, opposition critics cried.
"Only a Conservative minister bereft of emotion would think that children and pregnant women are abusing the health care system," said NDP MP Sadia Groguhe.
"The provinces, hospitals and health care professionals who are already overburdened are bearing the brunt of these consequences from the transfer of responsibilities for care of refugees from the federal government to the provinces."
Some provinces have said they won't be turning down requests for coverage, but have asked the federal government to rethink the changes.
Immigration Minister Jason Kenney insisted Monday the policy makes sense.
"If you come here as a visitor, a student, as a worker, as a new resident, you have to pay your own medical fees before becoming a permanent resident," he said.
"Why does the NDP want to force taxpayers to pick up the tab universally for illegal migrants? That makes no sense."
When the program was rolled out last year, the federal government was forced to scramble to figure out exactly to whom it would apply.
Initially, even those refugees who were resettled by the government were to have seen their benefits curtailed, although that was eventually changed.
The new policy is currently being challenged in Federal Court as an affront to the Charter of Rights and Freedoms.