Lessons from the US: Citizen or Not, Prevention is Key

May 8 2012


By Dr. Khati Hendry, CDM Board Member

To the editor;

As a family physician who previously worked in the United States, I can say from experience that limiting access to health care for refugees, or the millions of others left behind in that system, is both costly and cruel.  Yet that is exactly what our federal government has done with its recent changes to the Interim Federal health Program, reducing health care coverage to a bare minimum or only providing it in cases where it impacts public health. I was hoping I had left this sort of bad policy behind when I came to Canada.

What I saw in California was this:  When things get bad enough, people show up to health facilities in various states of crisis, and get some degree of treatment—although California did have to pass legislation to force the Emergency Rooms to see people in need, the patients avoid going in until they are in bad shape, they get a bill that could bankrupt them, and this is often later written-off by the biller because the person can’t pay.

It is contrary to humanitarian ideals that people be left in the ditch, and it makes terrible press, so there is usually some sort of "safety net" that evolves, generally described as “tattered”.  It may only be able to provide sub-optimal treatment, late in the course of illness and at a higher cost to the system, not to mention the patient.  Think of strokes or heart attacks that could have been prevented by treating hypertension.  People die unnecessarily.  The "provider of last resort" is almost always at least partially publicly-funded, such as the county hospital (if there still is one), a community health centre (if not needing hospitalization) or any hospital unable to figure out how to shift the care away from themselves.  The physicians are usually on salary in safety net settings, and the health facility (taxpayers) eats the cost, although in some cases individual physicians just write off the services when it can't be avoided.  You can imagine how it might play out in Canada, but I predict lots of angst all around.  The whole scenario of depriving people in your country of health care--whether you "want" them there or not--is not just cruel, but it drives up the overall cost of health care.

The proposals in Canada supposedly have exceptions for public health and safety, but there really is no good way to do this. Patients have no clue if their health concern qualifies, and usually neither does the treating physician. Where does public health start and end? Should people be seen for colds because they have a cough and it could be tuberculosis?  Should screening for chlamydia through routine gynecologic exams qualify?  What about providing prenatal care to check for HIV that could pass from mom to baby if not treated in time?  What about depressed or psychotic people who become homicidal?

The case of prenatal care is instructive—California ended up with special prenatal programs for undocumented immigrants because it was so conclusively demonstrated that there were huge cost savings if babies didn’t end up in intensive care from complications that could have been prevented. Sometimes money can talk, if not common decency and humanity.

In the end, restrictions on access to health care will not deter refugees, change the reasons they seek refuge, or save the system money. It’s just the sort of get tough rhetoric and action that make life meaner.  Canada deserves better.


Khati Hendry, MD

125 Sumac Ridge Dr.

Summerland, BC

V0H 1Z6

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