Abstract
BACKGROUND: 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.
OBJECTIVE: This study explores barriers occurring during the time period of the IFHP reforms to health care access and provision for refugees.
METHODS: 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.
RESULTS: 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. Afew stakeholders supported the reforms as they represented some, but limited, access to health care.
CONCLUSION: 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.
Key words: Refugees, health policy, Interim Federal Health Program, stakeholder analysis
Mots Clés: réfugiés, politique de santé, Programme fédéral de santé intérimaire, analyse des acteurs
Résumé
CONTEXTE : Les modifications apportées en 2012 au Programme fédéral de santé intérimaire (PFSI) ont réduit l’accès des réfugiés et des demandeurs du statut de réfugié aux soins de santé, ce qu’ont déploré les principaux acteurs du milieu. En 2014, un nouveau PFSI a temporairement restauré l’accès à certains services de santé; les rares informations disponibles sur ces modifications sont toutefois insuffisantes pour cartographier l’impact du nouveau PFSI.
OBJECTIF : Notre étude explore les obstacles survenus au cours de la période où des réformes ont été apportées à l’accessibilité et à la prestation des soins de santé aux réfugiés dans le PFSI.
MÉTHODE : Nous avons mené 23 entretiens semi-directifs pour analyser les perceptions des acteurs à l’égard des réformes de 2014, ainsi que la position des acteurs et leur influence sur l’évaluation de l’acceptabilité des modifications au PFSI.
RÉSULTATS : Les acteurs ont majoritairement exprimé des réserves à propos des modifications apportées au PFSI en 2014, en raison de la persistance des obstacles créés par la réduction des dépenses en 2012 et de l’émergence de nouveaux obstacles à l’accessibilité et à la prestation des soins de santé aux réfugiés. Les principaux obstacles qu’ils ont nommés étaient le manque de communication et de sensibilisation, le manque de continuité et d’intégralité des soins, le discours politique négatif et l’accroissement des coûts. Quelques acteurs étaient en faveur des réformes du fait qu’elles offraient un certain accès aux soins de santé, même si cet accès était limité.
CONCLUSION : Globalement, les réformes apportées au PFSI en 2014 ont créé des obstacles à l’accessibilité et à la prestation des soins de santé aux réfugiés, ce qui a contribué à la confusion chez les acteurs, au transfert de la responsabilité de la santé des réfugiés aux autorités provinciales et à la probabilité de creusement des disparités dans les résultats sanitaires, les réfugiés et les demandeurs du statut de réfugié choisissant d’attendre avant d’avoir recours aux soins de santé. L’étude recommande aux responsables des politiques de dialoguer avec les acteurs du milieu de la santé des réfugiés pour formuler une politique qui améliore l’accessibilité et la prestation des soins de santé pour les populations réfugiées.
Footnotes
Conflict of Interest: None to declare.
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