Lauren Vogel | CMAJ | February 14, 2019
Undocumented migrants often delay or are denied care they can’t afford, doctors say.
Health workers rallied in 17 cities across Canada this week to demand the federal government close gaps in medical coverage for undocumented migrants.
In a recent open letter, more than 1500 health professionals and organizations called for universal health care for all people living in Canada, regardless of their immigration status.
“Health care is a basic human right and something we as Canadians hold as a source of pride,” said Dr. Arnav Agarwal, an internal medicine resident at the University of Toronto and a signatory of the letter. “Yet, there are thousands of people who don’t have access to health care.”
It’s estimated that half a million people in Ontario alone aren’t covered by public health insurance because of their immigration status. Provinces and territories provide emergency services regardless of ability to pay and the federal government covers refugee claimants. But this still leaves many undocumented migrants with little to no coverage, Agarwal said. Those who are unable to pay out of pocket often delay care and may be denied some services.
The United Nations Human Rights Committee recently condemned Canada for refusing medical coverage to Nell Toussaint, an undocumented migrant who suffered serious health harms as a result. The committee gave the federal government 180 days to compensate Toussaint and review its legislation to ensure that migrants have access to essential health care.
That time is now up. The federal government maintains that it is not responsible for the health consequences people suffer if they choose to stay in Canada illegally. In a response to the committee, the government argued that Canada fulfills its humanitarian obligations by providing life-saving emergency services regardless of immigration status.
According to Agarwal, Canada is an “outlier” in this regard. Several European countries provide more comprehensive care regardless of immigration status, he said. Some have addressed concerns about medical tourism by giving undocumented migrants municipal identification cards, “which are different from permanent residency status but still qualify you as living there and provide access to health coverage.”
Such programs make both medical and economic sense, Agarwal noted. “It comes back to the question of prevention.” Delaying treatment until it’s an emergency increases the risk of complications and death, as well the cost of care, he said. “Many of these people come into hospital sicker, with more severe conditions and disease as a result of those delays, and also have worse outcomes.”
Photo credit: idildemir/iStock
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