Dr. Alexander Caudarella (@acaudarella) is a resident physician in family medicine at the University of Toronto; Dr. Andrea Evans (@ablairEvans) is a resident physician in pediatrics at the University of Toronto.
In June, 2012, the Canadian government cut funding to refugee health care with the claim that it would protect our immigration system from abuse. The following two years have seen street demonstrations, legal challenges and disagreements between the federal and provincial governments over the validity of these cuts.
Absent from the government's briefings and speeches has been any discussion of the impact these cuts would have on the most vulnerable of vulnerable populations – children. Our research team has analyzed data from the country's largest pediatric emergency room – The Hospital for Sick Children – and produced surprising results published in the international open source medical journal PLOS ONE.
In the six months following the cuts, 95 per cent of refugee claimant bills sent to the federal government were not paid. That means that 95 per cent of children presenting with valid health papers issued from the federal government were left without any emergency medical coverage. Make no mistake, these children were sick, with 12 per cent requiring admission. They were admitted, not with obscure or foreign diagnoses, but with life-threatening conditions that affect children everywhere – appendicitis, fractures, and seizures were among the diagnoses reported. The experience of a parent with no coverage and no money whose child is having a seizure in bed is something no research can properly capture.
Fortunately, these children received care because they presented to a centre large enough to absorb the costs of their treatment. What if they had instead gone to a small emergency room or urgent-care clinic?
Despite government assertions that the cuts will reduce health care costs, there are concerns that the changes in health care coverage will lead to a worsening of the health disparities in this already vulnerable population and increase overall long-term health and financial costs.
Thirty per cent of children in the study who ended up requiring admission to hospital are on the Designated Country of Origin list – a list of countries that are not covered for essential or emergency health care. This included children who required life-saving operations.
As the political debate raged, we were struck by how small the funds being debated actually are. Although the majority of refugees land in Toronto, and Sick Kids represents the city's only tertiary and level 1 pediatric trauma centre, the cost of caring for refugee claimant children in the emergency room and subsequently during admission for 12 months was only $130,000. In other words, a full year's care of refugees at one of Canada's largest hospitals is equivalent to approximately half of a federal cabinet minister's annual salary.
Citizenship and Immigration Minister Chris Alexander has asked the question "Why should a bogus refugee claimants get health care – in many cases more than Canadians were getting?".
We have our own questions. Why should a six-year-old child presenting to the SickKids emergency room with abdominal pain not be covered for an appendectomy? How is this more health care than what Canadians receive?
We know from other countries that uninsured people wait longer for care, have more disability and often present sicker than insured populations. We cannot wait for the front page of a newspaper to announce the death of a refugee child without coverage.
Regardless of where we fall on the political spectrum we must all realize that children are not bargaining chips for the politics of immigration policy. The federal Minister of Citizenship and Immigration must realize that there is no such thing as a "bogus child."