Canadian Medical Association Journal 1995; 153: 196
John Feeley, senior health economist at the CMA, says the issue has attracted the CMA's attention because a large number of people -- between 50 000 and 60 000 refugees -- are covered by the program at any one time.
Refugee claimants are initially seen by 1 of the 250 "designated medical practitioners" (DMPs) for their mandatory medical examination. The DMPs have been selected in designated areas on the basis of their cultural and language background. They are responsible for completing all initial medical examinations of indigent refugees, for which the federal government pays a fee of $70. (This includes completion of the form and provision of a medical examination.)
The immigration department has asked for CMA assistance in revising its medical report form used for immigration purposes. Feeley noted that much the same process that was used when the CMA helped revise the report form used by the Canada Pension Plan and Revenue Canada's disability-tax-credit program will be followed in this case.
Indigent refugee patients are not limited to physicians on the DMP list when they seek episodic medical care. Physicians who provide "covered" health care services to an indigent refugee are eligible for reimbursement according to fee-schedule rates in their province or territory.
Services that are not covered without prior approval include elective surgery, treatment of infertility problems, sports-medicine services and more than one visit to a psychiatrist.
"This is an important issue from the CMA's perspective because any practitioner could conceivably have to bill the Interim Federal Health Program," said Feeley. "We are keeping a close eye on the program because we have received a number of calls from physicians about recent changes to the terms and conditions of payment via the program."
Currently, the federal government will pay for:
He explained that the Interim Federal Health Program is designed as a stop-gap measure while refugees await coverage by provincial and territorial health-insurance plans. "This coverage varies by province," he said. "For instance, Quebec covers refugee claimants after 3 months, while British Columbia provides no coverage. Ontario used to cover indigent refugee claimants upon their arrival, but as of Apr. 1, 1995, it no longer covers their health care needs."
The federal program to provide immigration-related medical examinations and health care for refugees currently costs more than $23 million a year.
All invoices concerning services provided to refugees are to be sent to Funds Administrative Service, 9th Floor, 9707 - 110 St., Edmonton AB T5K 3T2; 800 770-2998. Physicians seeking further information can contact Dr. Roland Fuca, manager of the Interim Federal Health Program, 819 997- 1785, or Feeley, 800 267-9703, ext. 2262.