The massive increase in temporary immigration is affecting public services, which lack the means to cope. In addition to the arrival of asylum seekers, the health network must deal with the fact that a good proportion of non-permanent residents are not insured by the Régie de l’assurance santé du Québec ( RAMQ).
There are clients who have no insurance, others who have inadequate private insurance and still others who are covered by the federal government.
Who should pay out of pocket? Who can pay? Are there reimbursement mechanisms?
It is a headache for hospitals, for caregivers and for the clients themselves, who often have difficulty finding their way through the administrative maze. And above all, this has effects on the health of these patients.
At CHU Sainte-Justine, for example, the phenomenon has grown to such an extent that the director and head of the pediatrics department, Anne Monique Nuyt, asked to see the figures for the last year.
Result: 4% of all patients admitted to the Sainte-Justine emergency room and 6% of women who gave birth in this hospital did not have a “sun card”. In neonatal intensive care, this percentage increased to 9%.
PHOTO HUGO-SÉBASTIEN AUBERT, THE PRESS
The DD Anne Monique Nuyt, director and head of the pediatrics department at CHU Sainte-Justine
It is very heavy for those accompanying you. It is also difficult for doctors because, often, these are more complex medical conditions, treated later, and it is certain that we need interpreters.
The DD Anne Monique Nuyt, director and head of the pediatrics department at CHU Sainte-Justine
“It creates situations that are difficult to explain. There are cultural gaps, which means that it takes a lot of adaptation on the part of the teams to ensure the family’s trust in the system,” explains the DD Nuyt.
You should know that asylum seekers do not have access to RAMQ coverage, but that they are covered by the Interim Federal Health Program (PFSI).
“The issue is that their coverage is not exactly the same as that of the RAMQ,” underlines the specialist. But it is not so easy for them to have basic care, which would allow primary prevention.
“These are patients, by definition, who have seen a lot of trouble, and who may have serious health issues because they have not been taken care of. We had HIV cases that were not well treated because the mother, while traveling through the United States, even though she knew her diagnosis, did not have the means to buy the medication, etc. As a result, this increases the risk of transmission to the fetus, to the newborn. So, these are all difficult situations. »
A less discussed phenomenon
Most foreign students and temporary workers are not covered by RAMQ, nor are people without status.
“This is a problem that has existed for a very long time, but in recent years, there has been a significant increase in all groups of temporary immigrants,” specifies the Dr Marc Girard, director of professional services at CHU Sainte-Justine.
“There was the housing phenomenon, the school phenomenon. The health phenomenon has been less addressed,” he notes.
PHOTO HUGO-SÉBASTIEN AUBERT, THE PRESS
The Dr Marc Girard, director of professional services at CHU Sainte-Justine
The particularity of health is that demand is not something that can be programmed. The person who arrives here is often healthy or fairly healthy, or they think they are, and all of a sudden they develop an illness.
The Dr Marc Girard, director of professional services at CHU Sainte-Justine
According to the Dr Girard, newcomers are not always aware of the health resources available or the steps to take to access care. Often, asylum seekers, helpless in the face of administrative mazes, do not even know that their health needs are covered by the federal government.
“Temporary immigration is a price to pay if we want workers,” he explains. Food services, at the hospital, if I didn’t have people from other origins, I wouldn’t have many staff. Same thing for health. There are sectors that rely a lot on these people. We need it, so it puts pressure on our health system. It’s clear. »
We’re talking about health services, education, housing, it’s a bit our responsibility, in Quebec. We must better support migrants.
The Dr Marc Girard, director of professional services at CHU Sainte-Justine
This is also the opinion of Dr Jean-Lucien Rouleau, cardiologist and professor emeritus at the Faculty of Medicine of the University of Montreal, who advocates access to health for all.
“Here, at the Heart Institute, we receive a lot of people who arrive without RAMQ,” he says. We see them pro bono [sans frais]. The technicians do the exams on their lunch hour. Us too. So, we see them without penalizing people who have RAMQ. But we see quite a few. We do this because these people have needs. They are often not paid very well. »
There are some who have been here for 10, 15 years, without status. They develop health problems, and they go to the Médecins du monde clinic. We take care of them when they have heart problems.
The Dr Jean-Lucien Rouleau, cardiologist and professor emeritus at the Faculty of Medicine of the University of Montreal
Note: for the speakers interviewed by The Pressmedical tourism, this practice of coming to Quebec to receive care, is a marginal phenomenon, and does not constitute a problem as important as the lack of adequate coverage.
An explosion of needs
For its part, Médecins du monde observes an explosion in needs of all kinds. The cases are both more numerous and more complex, says Pénélope Boudreault, nurse and director of operations. national and strategic development of the organization, which welcomes the most vulnerable temporary immigrants.
PHOTO ROBERT SKINNER, LA PRESSE ARCHIVES
The Doctors of the World clinic, rue Crémazie Est
Among them, many temporary foreign workers and foreign students who have health problems, but also domestic violence, money and housing.
“Asylum seekers are another category of people,” says M.me Boudreault. We don’t see them here, they have medical coverage. We are talking about all the others: those who have status, therefore a study permit, a temporary work visa, a visitor visa, and people without status. »
PHOTO HUGO-SÉBASTIEN AUBERT, THE PRESS
Pénélope Boudreault, nurse and director of national operations and strategic development at Médecins du monde
To have access to care, they must pay the bill. Those who cannot pay are not treated, with some exceptions. Hospitals are only required to admit them when it is an emergency.
“A pregnant woman who has contractions every five minutes, her baby is going to come out, it’s an emergency”, illustrates Mme Boudreault. The hospital has an obligation to give birth. But there are plenty of pregnant women who have no pregnancy follow-up: no ultrasound, no check-up, nothing. These women come to the hospital when they are about to give birth because they cannot afford to pay the “package” required by the hospital for pregnancy monitoring and childbirth, “which is between $5,000 and $10,000.”
This creates an anomaly. In Quebec, all children born here are covered by RAMQ, if their parents reside in the territory. But since this coverage only begins at birth, it can affect the pregnancy and therefore the future health of the child.
“It’s difficult for the Quebec population to have access to a doctor,” she adds. When you don’t have RAMQ, it’s even worse, it’s even more complicated. »