New plan could ease access to health care for refugees. Some hospitals aren't buying in.

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Federal government cuts to the Interim Federal Health Program on June 30, 2012 left a large number of refugee claimants without access to medical care. Health-care professionals continue to resist through ongoing protests over cuts to health care for uninsured and refugee patients, and by creating systems to minimize the impact of the cuts.

In a ruling earlier this month, the Federal court called the cuts "cruel and unusual," saying they increase health risks, and reinforce negative stereotypes about refugees.

rabble.ca has learned that one of Toronto's largest hospital networks, the University Health Network (UHN) has not joined on to an agreement with Community Health Centres (CHC) that would make it easier for refugees and others who are not insured to access health-care services. 

Coordinated formal agreements between Community Health Centres, and many Toronto hospitals started in 2013. Under the agreements hospitals waive some of the registration fees that can discourage uninsured patients from seeking care.

"The objective of these agreements is to ensure non-insured patients have access to quality care," said Angela Robertson, the Executive Director of Queen West Community Health Centre. 

"Some fees that apply that are waived [such as] registration fees… the fee that some apply for registering a patient who is without insurance. This fee can range from $95 to over $400," she added.

So far, UHN has not agreed to take part in this formalized effort to ease access to non-emergency hospital care for uninsured and undocumented patients.

UHN includes four major hospitals in downtown Toronto: The Toronto Western Hospital, Toronto General Hospital, Princess Margaret Cancer Centre, and Toronto Rehabilitation Institute.

"Referred patients must be covered before they are accepted as patients in the UHN hospitals,"  said UHN Vice President of Public Affairs Gillian Howard in an email response to questions about the agreements. 

She added that the network's emergency departments provide care to anyone who has an emergent or urgent health issue.

Community Health Centres continue to refer patients to UHN hospitals for emergent and urgent care, since in Ontario, the costs for those health services are covered under the Ontario Temporary Health Program.

The CHC agreements would ease some of the financial burden of seeking non-emergency care. Hospital fees can make it difficult for undocumented and uninsured people to get the outpatient or diagnostic care they need.

Dr. Meb Rashid, clinical director of the Crossroads Clinic at Women's College Hospital in Toronto said that access to all levels of health care should be available to everyone residing in the country. If people cannot seek care during the early stages of their sickness, then they might end up in emergency rooms, where they can't be turned away.

"If there are many people without access to health care we know that's problematic," he said. "What you end up seeing, is the disease in a much more advanced stage and where it is much more expensive to treat."

A 2010 report from Women's College Hospital on care of uninsured patients shows just what can happen when hospitals demand fees for services. In one interview, a health-care worker reported situations where a Caesarean section was denied until fees were paid, or patients were not discharged until fees had been paid.

Community Health Centres (CHCs) in Toronto continue to reach out to hospitals to ensure non-insured patients have access to all forms of care. They have come together to build group agreements with local hospitals, said Robertson.

The report also discusses the barriers that many people residing in Canada face, when accessing health care. The report noted that the fear of receiving expensive hospital bills after accessing care prevented patients from visiting a hospital.

"A number of participants suggested that a significant amount of the time spent by CHC care providers was in advocating and negotiating with hospitals and other care providers to waive or reduce fees CHCs couldn't cover, or just to ensure that clients would actually be able to access services outside of the CHC."

The reports also listed worst-case scenarios faced by non-insured patients. The list included individuals harassed and intimidated when asked to pay bills, individuals denied care even with CHC referrals, and individuals who delayed seeking care until their health was severely compromised. 

Miriam Katawazi is a fourth-year journalism and human rights student at Carleton University and rabble's news intern. She has a strong passion for human rights and social justice in Canada and across the world. Her writing focuses on health, labour, education and human rights beats.

Meagan Perry is rabble.ca's editor-in-chief.

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