By Y.Y. Brandon Chen and Vanessa Gruben
Despite policy changes last April to Canada's refugee health care program, many people continue to be left without adequate access to health care.
That's the finding that comes out of a series of interviews we conducted recently with refugee service providers in Ottawa.
Health care for refugees in Canada falls under the responsibility of the Interim Federal Health Program (IFHP), and it has had some tumultuous years.
Many walk-in clinics, pharmacies and specialists continue to deny services to refugees and refugee claimants based on the false assumption that they are not covered.
In June 2012, the federal government made significant cuts to the program, leaving many refugees and refugee claimants without access to publicly-funded health care while causing serious confusion among health care providers.
Health care advocates challenged the cuts in the Federal Court and in 2014, the Court found the cuts violated the Charter as they were "cruel and unusual."
Following a change in government, the IFH was fully restored to its pre-2012 form last April. The reinstatement of IFHP was widely applauded -- but the reinstatement hasn't lived up to its promise.
The program, in theory, provides all refugee claimants with hospital and medical care coverage. It also provides all refugees and refugee claimants with supplementary coverage similar to that received by low-income Canadians.
So what's the problem?
Our interviews with refugee service providers reveal that, despite reinstatement, the IFHP remains plagued by "a legacy of confusion," as one practitioner put it. Because of the cuts in previous years, many walk-in clinics, pharmacies and specialists continue to deny services to refugees and refugee claimants based on the false assumption that they are not covered by the IFHP.
Even when service providers are aware of the IFHP's restoration, some are hesitant to see IFHP patients due to the program's perceived complexity. To be reimbursed by the program, health care practitioners must first register with the program, which many report as a cumbersome and slow process.
Once registered, many service providers complain about having trouble figuring out which services and treatments are covered. And the time it takes for providers to be paid by the IFHP seems to be inconsistent: while some providers have received reimbursement quickly, others have had to wait up to 90 days.
Many people expected that the reinstatement of the IFHP would reverse problems related to health care access encountered by refugees and refugee claimants during the years of cutbacks. The government claimed the renewed coverage would improve refugees' health outcomes. But one year later, this promise has not translated into reality.
The federal government must do more to protect and promote refugees' health and well-being.
Certainly, the government's decision to restore the IFHP has made a positive difference. Many previously uninsured persons can now obtain medically necessary treatment. Health care providers can now focus on treating patients, rather than worrying about how patients would pay for care. But the picture is far from perfect.
The federal government must do more to protect and promote refugees' health and well-being and make the promise of the IFHP a reality for all.
So what should be done?
First, more resources must be devoted to educating health care providers about the reinstated IFHP. Public education must also target refugee service providers outside the health care field, refugee sponsors and refugees themselves. This will better allow refugees and their allies to advocate for patients whose access to services is inappropriately denied.
Second, the IFHP registration and reimbursement procedures should be streamlined to encourage health professionals' participation in the program. Communications between IFHP administrators and refugee service providers should also be improved so that questions about the program can be answered promptly.
Third, coverage for medical interpretation services must be expanded. Currently, the program pays a modest amount of interpretation during refugees' post-arrival health assessment and when refugees access mental health care. This level of coverage is not enough. As many refugees are not yet proficient in English or French, their ability to fully access health care depends heavily on trained interpreters.
It has long been recognized by health experts that the extension of public health care is a critical first step in ensuring vulnerable people's access to health care. A year ago, the federal government took this all-important step with respect to refugees.
Now it is time for the government to go further and ensure that all refugees arriving in Canada actually receive the health care they need.
Y.Y. Brandon Chen and Vanessa Gruben are law professors and members of the University of Ottawa's Centre for Health Law, Policy and Ethics. They are currently co-leading a study on refugee service providers' experience with the reinstated Interim Federal Health Program."
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