Newcomers in Health Care Limbo – Quebec Groups Protest

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Community groups protest as Quebec joins Ontario, New Brunswick and British columbia in forcing new immigrants to spend three months in limbo before health care coverage kicks in. Women are especially vulnerable to the delay

by JILL HANLEY with Project Genesis

Marielle[1] came to work as a nanny in Canada on a temporary work permit under the Live-In Caregiver immigration program. Six weeks into her new job, Marielle became very ill. Soon afterwards, she was diagnosed with cancer and was no longer able to work. Although she had been told that she would be covered by provincial health insurance, she discovered that there was a 3-month waiting period before she would become fully insured. Unfortunately, she had become ill before the three months were up and was facing hospital bills in the tens of thousands of dollars. Although she recovered from her cancer, the debt Marielle accumulated has become a significant barrier to her dream of sponsoring her family to join her here in Canada.

Research has documented the many barriers to health faced by immigrant women: poor work conditions, high stress, cultural clashes with health service providers, gender and ethnic stereotypes at work in the health system, language barriers, and the list goes on. These forms of discrimination come together, for example, among immigrant women who, unable to find jobs in their fields of training, end up doing factory work: a supposedly docile workforce. After long years of repetitive work in unhealthy conditions, Quebec community groups have had many reports of older immigrant women being pushed out of their jobs. Rendered ill by the work, they are no longer considered good workers by their employers and are harassed to the point of quitting. However, several provinces around the country – most recently Quebec – have found a way to add one more barrier to the list. As of 2001, all permanent residents and temporary workers arriving in Quebec have had to wait three months from their declared arrival before being covered by public health insurance (referred to as the Délai de carence).

For Canadians migrating from other provinces to Quebec, this waiting period is bothersome but rarely dramatic; these people remain insured by their previous province of residence. The big change is in terms of health insurance for international migrants, people arriving in Quebec as permanent residents or temporary workers. In most cases, this means that unless they purchase expensive and/or limited private health insurance, newly arrived immigrants are unprotected from debt should they fall ill during their first three months. However, newly arrived immigrants generally do not have the means to purchase private services. For the more than 130,000 women migrants landing in Canada as immigrants per year (CIC, Facts & Figures 2005), three quarters of them dependent on a third party for their status, the likelihood of having the means to pay for private health care is even less.

Fear of "Health Tourism"

According to the current government, the introduction of this delay was meant to harmonize Quebec laws on this matter with those of its neighbouring provinces (Ontario and New Brunswick have a similar three-month waiting period, as does British Columbia), thereby avoiding abuse of the healthcare system by people who come to Quebec temporarily in order to benefit from free healthcare. However, the government has never offered any statistics or research to justify its fear of "health tourism". They have only provided a rough estimate of $2 million lost to "abuse" of the healthcare system (from a Health Care budget of many billions) without any mention of what role, if any, migrants play in this supposed abuse.

The decision is also unconvincing given the "healthy immigrant effect", which indicates that new immigrants make much less use of healthcare services than Canadian-born individuals. Not only are immigrants screened for good health before being allowed into Canada, but many also avoid using public services for minor health problems out of the fear of being considered a burden on Canadian society. There is a worry that being documented as having ill health will hurt their eventual efforts to become Canadian citizens.

Community Response

Not surprisingly, this rollback of immigrant rights brought on a strong response from the community organisations whose members began reporting stories similar to Marielle’s. The arguments against the health insurance delay were quick to arise. Quebec-wide coalitions, such as the « Alliance des Communautés Culturelles pour l’Égalité dans la Santé et les Services Sociaux » (ACCESSS) and the « Table de Concertation des Organismes au Service des Personnes Réfugiées et Immigrantes » (TCRI), opposed the new policy for its impacts on permanent residents, supported by community-based organisations such as Project Genesis and the Immigrant Workers’ Centre. Unwilling to accept this troubling restriction of human rights, we at Project Genesis, in coalition with many other community organisations, have demanded the abolition of the Délai de carence and access to public health care for all.

On a basic level of principles, Quebec’s Délai de carence contravenes the right to physical and mental health guaranteed in provincial, federal, and international human rights charters. In fact, in 1998, the Canadian Council for Refugees, the Canadian Council for Churches and the Inter-Church Committee for Refugees presented a brief to the UN arguing that Canada’s patchwork eligibility for health care coverage, which imposes lengthy waiting periods and disqualifies applicants on the basis of their status, or the status of their parents, violates Article 12(1)(d) of the International Covenant on Economic, Social and Cultural Rights by failing to "assure to all medical service and medical attention in the event of sickness" as well as Article 2(2) – that those rights be exercised without discrimination of any kind as to race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.[3]

In light of such UN provisions, and given the high cost of private insurance, the Délai denies recent migrants their right to health care. The Délai also works contrary to the government’s stated ideals of integration by sending migrants the message that they are "second-class citizens", a sense already documented to be widely present among women under sponsorship as wives or mothers[2]. And although they are technically legal, such délais also go against the spirit of universality and accessibility enshrined in the Canada Health Act.

On a technocratic level, community groups have also pointed out the irrationality of the policy. The government says the Délai "saves" $2 million, a mere 0.01% of the provinces $2 billion healthcare budget. Considering that 40,000 immigrants are affected by this rule per year, they represent only 6/10 of one percent of the population! So, even if they made an ‘average’ use of the healthcare system (which they don’t, given the previously mentioned "healthy immigrant effect"), covering new immigrants under the public health insurance would only cost $1 million -at most. Even more importantly, we have to remember that immigrants are not visitors here. They are integrating into Quebec and Canadian society and contribute through their labour and taxes from the moment of their landing and are therefore entitled to the same coverage as anyone else.

On a human level, community groups have seen many cases of families avoiding seeking health services because of prohibitive costs and being thrown into crisis when saddled with massive healthcare debt. We, at Project Genesis, have come across many cases where problems arose for hospitals and patients in terms of debt and debt collection, and consequent harassment, especially in a context where hospitals have been chronically under funded.

It is important to note that, for recent immigrants, massive debt has more serious repercussions than the usual fear of having your assets seized. For many newcomers to Quebec, sending remittances to their families was a major motivation for leaving their homes; losing the possibility of doing this is disastrous for them. Having to pay off healthcare debt can also delay the possibility of sponsoring other family members, thereby prolonging the heartbreaking family separation faced by so many migrants. For the more than 3,000 Live-In Caregivers arriving each year, such as Marielle, these considerations shape their decisions about accessing health care.

Research has shown that increased complexity in qualifications for public health insurance coverage increases bureaucratic confusion in health care establishments, brings intolerance toward those not holding medicare cards, and increases cases of refusal to treat. And, although community groups have convinced the government to allow certain exceptions to the Délai (notably in women’s prenatal care, infectious diseases and children’s vaccination), health care practitioners and health insurance bureaucrats are not always adequately informed of exceptions and of the details of the law, causing even more difficult situations for all those involved.

The Délai de carence differs from some of the other ways the government has introduced privatization into health care. This is the first time, for example, that an entire category of people – newly arrived immigrants and workers – have been excluded from public insurance.

In fact, the Délai is part of a larger trend toward the privatization of Quebec and Canada’s health care systems. The costs of this policy are being borne by new immigrants, to the profit of private insurance companies. And the costs to Canadian society of having a whole category of people who may not access healthcare when they need it have yet to be fully understood or calculated.

1. Not her real name.
2. Côté A, Kérisit M, Côté M: Sponsorship... for Better or Worse: The Impact of Sponsorship on the Equality Rights of Immigrant Women. Ottawa: Status of Women Canada; 2001
3. The full brief, 'A Draft Statement to the UN Committee on Economic, Social and Cultural Rights,' can be viewed at http://www.equalityrights.org/ngoun98/interchurch.htm