110 Interim Federal Health Program (IFHP): Survey of Access & Utilization by Pediatric Health Care Providers

Primary Subject area Public Health and Preventive Medicine Background Canada is currently facing an increasing number of refugees and refugee claimants, yet Canadian health professionals are underutilizing the system intended to provide these individuals with healthcare. The Interim Federal Health Program (IFHP) provides temporary healthcare coverage for those who are ineligible for provincial or territorial insurance, including resettled refugees and asylum seekers. Research suggests there are ongoing challenges around the program such as who is covered and what services are covered. Objectives The objective of this study was to assess Canadian pediatricians’ current understanding and utilization of the IFHP, and perceived barriers to its utilization. Design/Methods A one-time survey was administered via the Canadian Paediatric Surveillance Program. The ten question adaptive survey was available in English or French, in either paper or electronic format. Survey responses were collected for 6 weeks in early 2020 with two reminders sent prior to survey closing. In addition to descriptive statistics, multinomial logistic regressions were built to examine pediatrician use of the IFHP, work with IFHP-covered patients, and provider characteristics associated with registration and use. Results Of the 2,753 pediatricians and pediatric subspecialists surveyed, there were 1006 respondents (36.5% response rate). 52.2% of respondents had provided care to the IFHP-eligible patients in the previous 6 months. Of those participants, only 26.4% were registered IFHP providers, and just 10% could identify all services covered by the IFHP (Figure 1). Knowledge of 80% or more of supplemental benefits was associated with registration status (adjusted odds ratio [aOR] 1.92; 95% CI 1.09 - 3.37). Amongst those who knew they were not registered, 70.2% indicated they did not know they had to register. aOR demonstrated that those with fewer years of practice had higher odds of not knowing that they had to register (aOR 1.22; 95% CI 1.01 - 1.49) Conclusion We demonstrate that the IFHP is poorly utilized by pediatric providers, with low registration rates and poor understanding of the IFHP-covered supplemental services, even among those who have recently provided care to the IFHP-eligible patients. Efforts to improve registration and knowledge of the IFHP are essential to improving access to health care for refugee children and youth. Funding: Study funded by the CPSP Resident Research Grant

Interim Federal Health Program: Survey of access and utilization by paediatric health care providers

Background The Interim Federal Health Program (IFHP) provides health care coverage to refugees and refugee claimants, yet remains underused by providers. The objective of this study was to assess Canadian paediatricians’ current understanding and utilization of the IFHP, and perceived barriers to utilization. Methods A one-time survey was administered via the Canadian Paediatric Surveillance Program in February 2020. In addition to descriptive statistics, multinomial logistic regressions were built to examine paediatrician use of the IFHP, and characteristics associated with registration and use. Results Of the 2,753 physicians surveyed, there were 1,006 respondents (general paediatricians and subspecialists). 52.2% of respondents had provided care to IFHP-eligible patients in the previous 6 months. Of those participants, only 26.4% were registered IFHP providers, and just 16% could identify 80% or more of IFHP-covered services. Knowledge of 80% or more of IFHP-covered services was associated with registration status (adjusted odds ratio [aOR] 1.92; 95%CI 1.09 to 3.37). Among those who knew they were not registered, 70.2% indicated they did not know they had to register. aOR demonstrated that those with fewer years of practice had higher odds of not knowing that they had to register (aOR 1.22; 95%CI 1.01 to 1.49). Conclusions We demonstrate that IFHP is poorly utilized by paediatric providers, with low registration rates and poor understanding of IFHP-covered supplemental services, even among those who have recently provided care to IFHP-eligible patients. Efforts to improve registration and knowledge of IFHP are essential to improving access to health care for refugee children and youth.

The New Interim Federal Health Program: How Reduced Coverage Adversely Affects Refugee Claimants' Employment

The New Interim Federal Health Program: How Reduced Coverage Adversely Affects Refugee Claimants' Employment

The New Interim Federal Health Program: How Reduced Coverage Adversely Affects Refugee Claimants' Employment

The New Interim Federal Health Program: How Reduced Coverage Adversely Affects Refugee Claimants' Employment

(Re)Constructing and Resisting Irregularity: (Non)citizenship, Canada’s Interim Federal Health Program, and Access to Healthcare

This article analyzes the experiences of refugee claimants in Toronto’s everyday healthcare places, like walk-in clinics, doctor’s offices, and hospitals, in the aftermath of the 2012 Interim Federal Health Program (IFHP) revisions. By drawing upon critical migration scholarship that prioritizes (non)citizenship, as well as semi-structured interviews, I highlight how the social positioning of refugee claimants is modulated in ways that justify and extend the IFHP revisions to effectively deny access to healthcare, demonstrating the indeterminacy of access. I understand this process through the concept of irregularity, a non-juridical status that is contingently configured and enforced by state and non-state actors when one is (re)constructed as “out of place,” hence limiting access to resources and rights. In accordance with citizenship, it indicates how we can think of the (re)fashioning of people and groups particularly within the everyday. I follow this with a critical analysis of the contestations that emerged to challenge the IFHP revisions

“Part of Being Canadian is Having Access to Health Care”: Framing the Boundaries of Healthcare Deservingness for Non-Citizens through the Interim Federal Health Benefits Plan

Background In June 2012, the Canadian government cut eligibility to the Interim Federal Health Program (IFHP) for some refugees and refugee claimants.Analysis Drawing from news sources, this article examines the ways different actors—politicians and advocates—framed deservingness and undeservingness to support or contest the IFHP cuts. Deservingness refers to the ways value or worth is allocated to differently situated individuals based on their social location.Conclusions and implications The authors explore how deservingness is understood through a lens of citizenship, focusing on immigration status, understandings of “illegality” and criminalization of non-citizens, and varying versions of “Canadian values.” They argue that different interlocutors participated in the drawing and redrawing of boundaries of social and moral worth related to both presence in and access to social goods in Canada.RÉSUMÉContexte En juin 2012, le gouvernement canadien a réduit l’admissibilité au Programme fédéral de santé intérimaire (PFSI) de certains—certaines réfugiés-réfugiées et demandeursdemandeures d’asile.Analyse Tiré de sources d’actualité, cet article examine la manière dont différents acteurs—des politiciens et des défenseurs—ont conceptualisé le mérite et l’indignité pour appuyer ou contester les réductions du PFSI. Le mérite se réfère aux manières dont la valeur est attribuée aux individus situés différemment en fonction de leur emplacement social.Conclusions et implications Les auteures explorent la manière dont le mérite est compris dans l’optique de la citoyenneté, en se concentrant sur le statut d'immigration, la compréhension de « l’illégalité » et la criminalisation des non-citoyens et diverses versions des « valeurs canadiennes ». Elles soutiennent que différents interlocuteurs ont participé a établir et redéfinir les limites de la valeur sociale et morale liées à la présence et à l’accès aux biens sociaux au Canada.

“A Legacy of Confusion”: An Exploratory Study of Service Provision under the Reinstated Interim Federal Health Program

Afer years of cuts, Canada’s refugee health-care program, the Interim Federal Health Program (IFHP), was fully restored in 2016. In this exploratory study, eleven semi-structured qualitative interviews were conducted with refugee service providers in the City of Ottawa to learn about their experience with the restored IFHP to date. Five themes emerged from the interviews: service provision challenges during the years of IFHP cuts; support for IFHP restoration; entitlement gaps in the current IFHP; ongoing confusion about the IFHP; and administrative barriers deterring health professionals from IFHP participation. More research is needed to determine whether the identifed challenges with the reinstated IFHP arise on a national scale.

In the Name of Humanitarianism: The Interim Federal Health Program and the Irregularization of Refugee Claimants

Since 1957 Canada’s Interim Federal Health Program (IFHP) has provided health-care coverage to refugee populations. However, from June 2012 to April 2016 the program was drastically revised in ways that restricted or denied access to health-care coverage, specifically to refugee claimants—persons who have fed their country and made an asylum claim in another country. One of the main intentions of the revision was to protect the integrity of Canada’s humanitarian refugee determination system. However, this had a major unintended consequence: within everyday healthcare places like walk-in clinics, doctor’s offices, and hospitals, IFHP recipients were denied access to services, regardless of actual levels of coverage. In this article I analyze how these program restrictions were experienced within Toronto’s everyday health-care places through the concept of irregularization. I discuss how the IFHP, as a humanitarian health-care program, problematizes the presence of refugee claimants in ways that created experiences of vulnerability, insecurity, and anxiety. Building on this view, I conclude with a discussion of how activists who sought to draw attention to the experiences of refugee claimants in the aftermath of the IFHP revisions closed of truly transformative pathways toward social justice.