Impacts of the Interim Federal Health Program on Healthcare Access and Provision for Refugees and Refugee Claimants in Canada: A Stakeholder Analysis
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Background: Refugees and refugee claimants experience health needs upon arrival in Canada. Retrenchments to the Interim Federal Health program (IFHP) in 2012 greatly reduced healthcare access for refugee claimants, generating concerns among healthcare providers and other stakeholders affected by the reforms. In 2014 a new IFH program temporarily reinstated access to some health services however, little is known about the reforms and more information is needed to map its impact on key stakeholders. This study aims to examine the perception of key stakeholders regarding the impact of the 2014 reforms on the policy’s intermediary goals: access and provision of healthcare.
Methodology: Data was collected using semi-structured key informant interviews with refugee health policy stakeholders (n=23), refugees and refugee claimants (n=6), policy makers and government officials (n=5), civil society organizations (n=6) and professionals and practitioners (n=6). Data was analysed using a constant comparative approach with NVivo 10 (QSR International). A stakeholder analysis was used to map out key stakeholder perceptions, interests and influences in refugee health policy and a content analysis was further employed to abstract themes associated with barriers and facilitators to access and provision of healthcare in the current situation.
Results: The findings provide information for management of stakeholder engagement revealing the perceptions of key stakeholders on the 2014 reforms: eight were opposed to the reforms, eight held mixed positions, four supported the reforms and one did not comment. Five facilitators to accessing healthcare were identified. Eighteen themes emerged under four health care access and provision barrier categories: cognitive, socio-political, structural and financial. There were four common themes perceived among all stakeholder groups: lack of communication and awareness of refugee and provider, lack of care provider training leading to unfamiliarity with IFHP, lack of continuity and comprehensive care and the political discourse leading to refugee and claimant social exclusion. Other common barrier themes included healthcare affordability for refugees and the healthcare system, fear of the healthcare system, and interaction with the Ontario Temporary Health Program.
Conclusion: The study highlights that reforms to the IFHP in 2014 have transferred refugee health responsibility to provincial authorities and healthcare institutions resulting in bureaucratic strains, inefficiencies, overburdened administration and increased health outcome disparities as refugees and claimants choose to delay seeking healthcare due to existing barriers. There are some benefits to the reforms, but the lack of support and mixed opinions among the majority of stakeholders emphasize the need for reformulation of policy with stakeholder engagement. This study recommends future refugee health reform strategies incorporate stakeholder leadership, cooperation and perspectives, as revealed in this research, to successfully move healthcare policy from theory to practice.
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