IRCC Minister Transition Binder 2019: Migration Health

Background

IRCC is the Government of Canada lead on migration health-related issues

• A key component of IRCC’s mandate is to facilitate the legitimate entry of newcomers while protecting the health, safety and security of Canadians.

IRCC helps protect public health and the healthcare system

• By managing health screening of migrants to prevent the arrival of infectious diseases (e.g., active tuberculosis)
• By notifying provinces/territories of the arrival of newcomers requiring medical surveillance (e.g., latent tuberculosis, HIV)

IRCC administers the Interim Federal Health Program

• The Interim Federal Health Program provides temporary healthcare coverage to refugees, asylum seekers, and other vulnerable populations until they become eligible for provincial/territorial health coverage.

Health Screening

Immigration Medical Exams

• Immigration Medical Exams are the cornerstone of the health screening process. These exams help protect the public health of Canadians and prevent the spread of diseases. The process includes:
  • Medical history
  • Health exam
  • Lab tests for some communicable diseases
  • X-rays to check for tuberculosis
  • Complete medical file is reviewed and finalized by immigration health officials
• Immigration Medical Examinations are required for foreign nationals who plan to:
  • visit for more than six months
  • work in healthcare or with children
  • apply for permanent residence
• Foreign nationals visiting for less than six months do not require an Immigration Medical Exam.
• All applicants (except refugees and asylum claimants) pay for medical examinations.

Panel Physicians

• IRCC-designated panel physicians are
  third-party medical professionals who complete Immigration Medical Exams.
  • IRCC performs regular quality assurance activities through its four Regional Medical Offices (Ottawa, London, Delhi and Manila).
• If a panel physician finds an infectious disease as a result of the Immigration Medical Exam, the applicant’s immigration application is put on hold pending a follow-up examination and treatment is provided.

Did you know?

• There are over 2,300 panel physicians and radiologists, located in 170 countries, including Canada.

Assessing Results

• IRCC assesses the results of Immigration Medical Exams to determine inadmissibility on three health grounds under the Immigration and Refugee Protection Act:
• Clients who had previously-treated tuberculosis or suspected latent tuberculosis infection are admitted to Canada but referred to provincial/territorial public health authorities for medical surveillance, facilitating admissions while ensuring continuity of care.

Danger to Public Health

• 7% of all cases of health inadmissibility
• Includes active tuberculosis and untreated syphilis
• IRCC also screens for HIV, latent tuberculosis and hepatitis, to ensure continuity of care

Danger to Public Safety

• 2% of all cases of health inadmissibility
• Includes conditions such as severe mental health problems (e.g., an untreated psychotic disorder with a history of violence)

Excessive Demand on Health or Social Services

• 91% of all cases of health inadmissibility
• A determination of whether an applicant’s health condition(s) would exceed three times the average Canadian per capita cost for health services, or would impact wait lists for certain procedures or services
• No condition automatically leads to inadmissibility based on excessive demand

Outcomes (2017)

• In 2017^{Note de bas de page *}, Immigration Medical Exams helped prevent Canadian public health risks:
  • 581 cases of active (contagious) tuberculosis were prevented from coming to Canada until fully treated.
    • Permanent residents: 87 cases per 100,000 Immigration Medical Exams
    • Temporary residents: 112 cases per 100,000 Immigration Medical Exams
  • 10,891 clients were identified as requiring to report to their local Canadian health authority for medical surveillance due to latent or previously-treated tuberculosis.
• Immigration Medical Exams were also used to notify the provinces and territories of the arrival of clients with HIV to ensure support for continuity of care

Interim Federal Health Program

• The In-Canada Interim Federal Health Program provides limited and temporary coverage of healthcare benefits to refugees, asylum seekers, and other vulnerable populations, which includes:
  • Basic coverage similar to provincial/territorial healthcare insurance
  • Supplemental coverage and prescription drug coverage similar to what provinces/territories provide to Canadians who receive social assistance
• Asylum seekers receive health coverage until a positive decision is made on their claim, or until removal.
• The Overseas Interim Federal Health Program covers certain pre-departure medical services for refugees coming to Canada for resettlement including:
  • Immigration medical exams and follow-up treatment of health conditions
  • Vaccinations
  • Outbreak management and control
  • Medical support needed for safe travel

In-Canada Interim Federal Health Program Process

• Eligible clients are issued a document by the Canada Border Services Agency or IRCC inland officers which confirms that they are eligible for health coverage.
• IRCC provides an online list beneficiaries can use to search for an Interim Federal Health Program provider.
• To use the services of an Interim Federal Health Program provider (e.g., hospitals, doctors, pharmacists), the beneficiary shows proof of coverage.
• The Interim Federal Health service provider bills IRCC via a third-party claims administrator (currently Medavie Blue Cross).
• IRCC does not reimburse clients directly.
• IRCC does not issue payment to provinces/territories – the Interim Federal Health Program is a separate, parallel health insurance scheme to provincial coverage.

Claims Administration Modernization Project 

• The current contract with Medavie Blue Cross is expiring and a procurement process is underway to deliver enhanced services to both providers and beneficiaries.

Costs

The cost of the Interim Federal Health Program has been increasing year over year, aligning with increases of beneficiaries.

Key Takeaways

Results

• The Migration Health Program plays a key role in supporting IRCC’s mandate of facilitating the legitimate entry of newcomers while protecting the health, safety and security of Canadians by:
  • preventing the arrival of infectious diseases;
  • collaborating with provinces and territories for clients who require medical surveillance by local Canadian health authorities; and
  • ensuring the sustainability of Canada’s publicly-funded healthcare systems through the Interim Federal Health Program.