Antonipillai Valentina, Baumann Andrea, Hunter Andrea, Wahoush Olive, O'Shea Timothy
Health Policy PhD Program, McMaster University, Hamilton, ON; Global Health, McMaster University, Hamilton, ON.
Can J Public Health. 2017 Nov 9;108(4):e435-e441. doi: 10.17269/cjph.108.5553.
Changes to the Interim Federal Health Program (IFHP) in 2012 reduced health care access for refugees and refugee claimants, generating concerns among key stakeholders. In 2014, a new IFHP temporarily reinstated access to some health services; however, little is known about these changes, and more information is needed to map the IFHP's impact.
This study explores barriers occurring during the time period of the IFHP reforms to health care access and provision for refugees.
A stakeholder analysis, using 23 semi-structured interviews, was conducted to obtain insight into stakeholder perceptions of the 2014 reforms, as well as stakeholders' position and their influence to assess the acceptability of the IFHP changes.
The majority of stakeholders expressed concerns about the 2014 IFHP changes as a result of the continuing barriers posed by the 2012 retrenchments and the emergence of new barriers to health care access and provision for refugees. Key barriers identified included lack of communication and awareness, lack of continuity and comprehensive care, negative political discourse and increased costs. A few stakeholders supported the reforms as they represented some, but limited, access to health care.
Overall, the reforms to the IFHP in 2014 generated barriers to health care access and provision that contributed to confusion among stakeholders, the transfer of refugee health responsibility to provincial authorities and the likelihood of increased health outcome disparities, as refugees and refugee claimants chose to delay seeking health care. The study recommends that policy-makers engage with refugee health stakeholders to formulate a policy that improves health care provision and access for refugee populations.
2012年《临时联邦健康计划》（IFHP）的变更减少了难民和难民申请者获得医疗保健的机会，引发了主要利益相关者的担忧。2014年，一项新的IFHP暂时恢复了部分医疗服务的获取；然而，人们对这些变更知之甚少，需要更多信息来评估IFHP的影响。
本研究探讨在IFHP改革期间出现的难民获得医疗保健及医疗服务提供方面的障碍。
进行了一项利益相关者分析，采用23次半结构化访谈，以深入了解利益相关者对2014年改革的看法，以及利益相关者的立场及其影响力，以评估IFHP变更的可接受性。
由于2012年削减措施造成的持续障碍以及难民获得医疗保健及医疗服务提供方面新障碍的出现，大多数利益相关者对2014年IFHP的变更表示担忧。确定的主要障碍包括缺乏沟通和认知、缺乏连续性和全面护理、负面的政治言论以及成本增加。一些利益相关者支持这些改革，因为它们代表了获得某些但有限的医疗保健机会。
总体而言，2014年IFHP的改革给医疗保健的获取和提供带来了障碍，导致利益相关者之间产生困惑，难民健康责任转移到省级当局，以及健康结果差距扩大的可能性增加，因为难民和难民申请者选择推迟寻求医疗保健。该研究建议政策制定者与难民健康利益相关者合作，制定一项改善难民群体医疗服务提供和获取的政策。
