Interim Federal Health Program Research Articles

34 Using Spatial Analysis to Identify Access to IFHP-registered Paediatric Providers in Ontario

Abstract Introduction/Background Compared to non-refugees, child refugees face a wide array of health disparities, including higher levels of nutritional deficiencies, infectious diseases, and mental illness secondary to experienced poverty, trauma, and migration. After migration, refugee families continue to face health inequities, necessitating access to health care. In Canada, the Interim Federal Health Program (IFHP) provides temporary health care benefits to refugees and refugee claimants who are ineligible for provincial or territorial health insurance. The program requires healthcare providers to register to be reimbursed for care provided. However, physicians are not required to register for IFHP, leading to fewer providers. Objectives This study aimed to map where IFHP-registered primary care physicians (PCPs) and paediatricians live and work in Ontario, relative to where IFHP-insured patients live, to identify geographic accessibility of primary healthcare services for paediatric refugee populations. Design/Methods We performed spatial analysis using ArcMap (version 10.8.2), a geographic information system (GIS). The practice location of PCPs and paediatricians registered for IFHP as of December 2021 were geocoded and the percent of IHFP provider per population for each Census Tract (CT) was calculated. Refugee populations eligible for IFHP in Ontario by CT, as identified by the 2016 Canadian Census, were calculated as percentages and per 10,000 population, and linked to geospatial data for comparison. Ratios of IFHP providers to refugees were calculated for each CT. Results At the time of data collection, there were 481,710 documented refugees living in Ontario, and 11,854 IFHP-registered paediatricians or PCPs. Toronto, Windsor, and Kitchener-Waterloo had the largest percentages of refugees per population (5.4%, 5.1%, and 4.6%, respectively), while Toronto, Hamilton, and London had the highest percentage of IFHP providers per population (0.13%, 0.11%, and 0.09%, respectively). Generally, CTs with the highest proportion of refugees had more IFHP-registered providers, and rural areas had the fewest number of both refugees and IFHP-registered providers. However, there were 941 CTs recognized across Ontario with identified refugee populations but no registered IFHP providers. The CTs with the highest ratio of IFHP providers to refugees were in Toronto and Ottawa (3.9, 2.0 in Toronto, and 2.1 in Ottawa, respectively). Conclusion While some regions with large refugee populations have registered IFHP PCP providers, there are regions that are relative IFHP provider-deserts for resident refugees. Identifying areas where geographic barriers are likely to exist in Ontario is necessary to improve accessibility of existing services and could help reduce healthcare inequities faced by the refugee population.

Differences in severity of cervical dysplasia between Ontario residents and refugees

Our study aims to compare the grade of cervical dysplasia by histology at initial presentation to colposcopy clinic between patients billing through Interim Federal Health Program (IFHP) ,as a proxy for refugee status, and patients billing through Ontario Health Insurance Plan (OHIP). We hypothesize that refugees present with a higher grade of dysplasia compared to Ontario residents.

Interim Federal Health Program: Survey of use of supplemental benefits by paediatric health care providers.

The Interim Federal Health Program (IFHP) provides temporary healthcare coverage to refugees and refugee claimants. Previous research demonstrates that paediatric healthcare providers poorly utilize the IFHP, with low registration rates and limited understanding of the program. The objective of this study was to examine paediatric provider use of IFHP-covered supplemental benefits, and their experience with trying to access these benefits. A one-time survey was administered via the Canadian Paediatric Surveillance Program in February 2020. Of those who had provided care to IFHP-eligible patients, descriptive tables and statistics were created looking at provider demographics, and experience using the IFHP supplemental benefits. A multinomial logistic regression was built to look at provider characteristics associated with trying to access supplemental benefits. Of the 2,753 physicians surveyed, there were 1,006 respondents (general paediatricians and subspecialists). Of the respondents, 526 had recently provided care to IFHP-eligible patients. Just over 30% of those who had recently provided care did not access supplemental benefits as they did not know they were covered by the IFHP. Of those who had tried to access supplemental benefits, over 80% described their experience as difficult, or very difficult. Paediatric providers have a poor understanding of IFHP-covered supplemental benefits, which is cited as a reason for not trying to access supplemental benefits. Of those who do try to access these benefits, they describe the process as difficult. Efforts should be made to improve provider knowledge and streamline the process to improve access to healthcare for refugee children and youth.

Should Canada Pay for Refugee Healthcare? A Social Justice Analysis of the Interim Federal Health Program (IFHP)

The global refugee crisis and the increased number of refugees seeking asylum in Canada has led the federal government to enact a series of policy reforms related to refugee healthcare coverage and spending. This paper provides a critical review of the Interim Federal Health Program (IFHP), drawing on concepts from social justice, migration, and market-oriented theories while examining policy rhetoric, legal ramifications, and media portrayals. The recommendations in this article aim to reduce health inequities and healthcare access barriers for the refugee population in Canada. Findings suggest Canadian federal policies have contributed to refugee health disparities.

A Critical Look at Refugee Healthcare in Canada

The Interim Federal Health Program (IFHP) was initiated in 1957 by the Canadian government to provide basic health insurance for refugees and refugee claimants. After a series of budgetcuts in 2012 and reinstatement of services in 2016, the IFHP has been met with confusion by healthcare professionals. Complex administrative processes have led to reluctance in providing care for refugees, including refugee claimants, by various healthcare providers. Refugees already face several barriers that hinder their ability to access care. Given the lack of awareness around the IFHP amongst professionals, this paper outlines recommendations and actionable steps for various key stakeholders to improve their knowledge of and commitment to the IFHP. Potential strategies include advocating for a simplified administrative process, holding government officials accountable for poor policy implementation, and enlisting the help of civil society organizations to raise awareness about the IFHP. These interventions are the first step in ensuring that the values of equity and multiculturalism are embraced in the healthcare system.

110 Interim Federal Health Program (IFHP): Survey of Access & Utilization by Pediatric Health Care Providers

Abstract Primary Subject area Public Health and Preventive Medicine Background Canada is currently facing an increasing number of refugees and refugee claimants, yet Canadian health professionals are underutilizing the system intended to provide these individuals with healthcare. The Interim Federal Health Program (IFHP) provides temporary healthcare coverage for those who are ineligible for provincial or territorial insurance, including resettled refugees and asylum seekers. Research suggests there are ongoing challenges around the program such as who is covered and what services are covered. Objectives The objective of this study was to assess Canadian pediatricians’ current understanding and utilization of the IFHP, and perceived barriers to its utilization. Design/Methods A one-time survey was administered via the Canadian Paediatric Surveillance Program. The ten question adaptive survey was available in English or French, in either paper or electronic format. Survey responses were collected for 6 weeks in early 2020 with two reminders sent prior to survey closing. In addition to descriptive statistics, multinomial logistic regressions were built to examine pediatrician use of the IFHP, work with IFHP-covered patients, and provider characteristics associated with registration and use. Results Of the 2,753 pediatricians and pediatric subspecialists surveyed, there were 1006 respondents (36.5% response rate). 52.2% of respondents had provided care to the IFHP-eligible patients in the previous 6 months. Of those participants, only 26.4% were registered IFHP providers, and just 10% could identify all services covered by the IFHP (Figure 1). Knowledge of 80% or more of supplemental benefits was associated with registration status (adjusted odds ratio [aOR] 1.92; 95% CI 1.09 - 3.37). Amongst those who knew they were not registered, 70.2% indicated they did not know they had to register. aOR demonstrated that those with fewer years of practice had higher odds of not knowing that they had to register (aOR 1.22; 95% CI 1.01 - 1.49) Conclusion We demonstrate that the IFHP is poorly utilized by pediatric providers, with low registration rates and poor understanding of the IFHP-covered supplemental services, even among those who have recently provided care to the IFHP-eligible patients. Efforts to improve registration and knowledge of the IFHP are essential to improving access to health care for refugee children and youth. Funding: Study funded by the CPSP Resident Research Grant

Advancing Our Understanding of Dental Care Pathways of Refugees and Asylum Seekers in Canada: A Qualitative Study

The burden of oral diseases and need for dental care are high among refugees and asylum seekers (humanitarian migrants). Canada’s Interim Federal Health Program (IFHP) provides humanitarian migrants with limited dental services; however, this program has seen several fluctuations over the past decade. An earlier study on the experiences of humanitarian migrants in Quebec, Canada, developed the dental care pathways of humanitarian migrants model, which describes the care-seeking processes that humanitarian migrants follow; further, this study documented shortfalls in IFHP coverage. The current qualitative study tests the pathway model in another Canadian province. We purposefully recruited 27 humanitarian migrants from 13 countries in four global regions, between April and December 2019, in two Ontario cities (Toronto and Ottawa). Four focus group discussions were facilitated in English, Arabic, Spanish, and Dari. Analysis revealed barriers to care similar to the Quebec study: Waiting time, financial, and language barriers. Further, participants were unsatisfied with the IFHP’s benefits package. Our data produced two new pathways for the model: transnational dental care and self-medication. In conclusion, the dental care needs of humanitarian migrants are not currently being met in Canada, forcing participants to resort to alternative pathways outside the conventional dental care system.

Interim Federal Health Program: Survey of access and utilization by paediatric health care providers.

The Interim Federal Health Program (IFHP) provides health care coverage to refugees and refugee claimants, yet remains underused by providers. The objective of this study was to assess Canadian paediatricians' current understanding and utilization of the IFHP, and perceived barriers to utilization. A one-time survey was administered via the Canadian Paediatric Surveillance Program in February 2020. In addition to descriptive statistics, multinomial logistic regressions were built to examine paediatrician use of the IFHP, and characteristics associated with registration and use. Of the 2,753 physicians surveyed, there were 1,006 respondents (general paediatricians and subspecialists). 52.2% of respondents had provided care to IFHP-eligible patients in the previous 6 months. Of those participants, only 26.4% were registered IFHP providers, and just 16% could identify 80% or more of IFHP-covered services. Knowledge of 80% or more of IFHP-covered services was associated with registration status (adjusted odds ratio [aOR] 1.92; 95%CI 1.09 to 3.37). Among those who knew they were not registered, 70.2% indicated they did not know they had to register. aOR demonstrated that those with fewer years of practice had higher odds of not knowing that they had to register (aOR 1.22; 95%CI 1.01 to 1.49). We demonstrate that IFHP is poorly utilized by paediatric providers, with low registration rates and poor understanding of IFHP-covered supplemental services, even among those who have recently provided care to IFHP-eligible patients. Efforts to improve registration and knowledge of IFHP are essential to improving access to health care for refugee children and youth.

Refugee health care funding in Canada

Due to a steady rise in the number of refugees accepted by Canada in recent years, the need for government funding to cover the health care needs of this population has similarly increased. Despite this increased need, government funding via the Interim Federal Health Program (IFHP) was cut dramatically in 2012 by the Conservative government. In 2016, the Liberal government restored full refugee health care coverage. This article provides an overview of refugee health care funding decisions in Canada over the past decade, and explores the impact that such decisions have on the health outcomes of this population. Furthermore, this article compares and contrasts refugee health care funding in Canada with that in other world regions with high refugee influx. Key potential areas for funding improvement are identified.

(Re)Constructing and Resisting Irregularity: (Non)citizenship, Canada’s Interim Federal Health Program, and Access to Healthcare

This article analyzes the experiences of refugee claimants in Toronto’s everyday healthcare places, like walk-in clinics, doctor’s offices, and hospitals, in the aftermath of the 2012 Interim Federal Health Program (IFHP) revisions. By drawing upon critical migration scholarship that prioritizes (non)citizenship, as well as semi-structured interviews, I highlight how the social positioning of refugee claimants is modulated in ways that justify and extend the IFHP revisions to effectively deny access to healthcare, demonstrating the indeterminacy of access. I understand this process through the concept of irregularity, a non-juridical status that is contingently configured and enforced by state and non-state actors when one is (re)constructed as “out of place,” hence limiting access to resources and rights. In accordance with citizenship, it indicates how we can think of the (re)fashioning of people and groups particularly within the everyday. I follow this with a critical analysis of the contestations that emerged to challenge the IFHP revisions

“Part of Being Canadian Is Having Access to Healthcare”: Framing the Boundaries of Healthcare Deservingness for Non-Citizens through the Interim Federal Health Benefits Program

Background In June 2012, the Canadian government cut eligibility to the Interim Federal Health Program (IFHP) for some refugees and refugee claimants. Analysis Drawing from news sources, this article examines the ways different actors—politicians and advocates—framed deservingness and undeservingness to support or contest the IFHP cuts. Deservingness refers to the ways value or worth is allocated to differently situated individuals based on their social location. Conclusions and implications The authors explore how deservingness is understood through a lens of citizenship, focusing on immigration status, understandings of “illegality” and criminalization of non-citizens, and varying versions of “Canadian values.” They argue that different interlocutors participated in the drawing and redrawing of boundaries of social and moral worth related to both presence in and access to social goods in Canada.

“A Legacy of Confusion”: An Exploratory Study of Service Provision under the Reinstated Interim Federal Health Program

Afer years of cuts, Canada’s refugee health-care program, the Interim Federal Health Program (IFHP), was fully restored in 2016. In this exploratory study, eleven semi-structured qualitative interviews were conducted with refugee service providers in the City of Ottawa to learn about their experience with the restored IFHP to date. Five themes emerged from the interviews: service provision challenges during the years of IFHP cuts; support for IFHP restoration; entitlement gaps in the current IFHP; ongoing confusion about the IFHP; and administrative barriers deterring health professionals from IFHP participation. More research is needed to determine whether the identifed challenges with the reinstated IFHP arise on a national scale.

In the Name of Humanitarianism: The Interim Federal Health Program and the Irregularization of Refugee Claimants

Since 1957 Canada’s Interim Federal Health Program (IFHP) has provided health-care coverage to refugee populations. However, from June 2012 to April 2016 the program was drastically revised in ways that restricted or denied access to health-care coverage, specifically to refugee claimants—persons who have fed their country and made an asylum claim in another country. One of the main intentions of the revision was to protect the integrity of Canada’s humanitarian refugee determination system. However, this had a major unintended consequence: within everyday healthcare places like walk-in clinics, doctor’s offices, and hospitals, IFHP recipients were denied access to services, regardless of actual levels of coverage. In this article I analyze how these program restrictions were experienced within Toronto’s everyday health-care places through the concept of irregularization. I discuss how the IFHP, as a humanitarian health-care program, problematizes the presence of refugee claimants in ways that created experiences of vulnerability, insecurity, and anxiety. Building on this view, I conclude with a discussion of how activists who sought to draw attention to the experiences of refugee claimants in the aftermath of the IFHP revisions closed of truly transformative pathways toward social justice.

Use of the emergency department by refugees under the Interim Federal Health Program: A health records review.

IntroductionIn June 2012, the federal government made cuts to the Interim Federal Health (IFH) Program that reduced or eliminated health insurance for refugee claimants in Canada. The purpose of this study was to examine the effect of the cuts on emergency department (ED) use among patients claiming IFH benefits.MethodsWe conducted a health records review at two tertiary care EDs in Ottawa. We reviewed all ED visits where an IFH claim was made at triage, for 18 months before and 18 months after the changes to the program on June 30, 2012 (2011–2013). Claims made before and after the cuts were compared in terms of basic demographics, chief presenting complaints, acuity, diagnosis, presence of primary care, and financial status of the claim. Bivariate or multivariate logistic regression analysis was performed to yield odds ratios (OR) with 95% confidence intervals.ResultsThere were a total of 612 IFH claims made in the ED from 2011–2013. The demographic characteristics, acuity of presentation and discharge diagnoses were similar during both the before and after periods. Overall, 28.6% fewer claims were made under the IFH program after the cuts. Of the claims made, significantly more were rejected after the cuts than before (13.7% after vs. 3.9% before, adjusted OR 4.28, 95% CI: 2.18–8.40; p<0.05). The majority (75.0%) of rejected claims have not been paid by patients. Fewer patients after the cuts indicated that they had a family physician (20.4% after vs. 30% before, unadjusted OR 1.67, 95% CI: 1.14–2.44; p<0.05) yet a higher proportion of patients without a family physician were still advised to follow up with their family doctor during the after period (67.2% after vs. 41.8% before, unadjusted OR 2.85, 95% CI: 1.45–5.62; p<0.05).ConclusionA higher proportion of both rejected and subsequently unpaid claims after the IFH cuts in June 2012, as demonstrated in the logistic regression analysis in this health records review, represents a potential barrier to emergency medical care, as well as a new financial burden to be shouldered by patients and hospitals. A reduction in IFH claims in the ED and a reduction in the number of patients with access to a family physician also suggests inadequate primary care for this population, yet this was not reflected in the follow-up advice offered by ED physicians to patients.

MP05: Injuries in refugee children presenting to a paediatric emergency department

Introduction: The number of refugees accepted to Canada grew from 24,600 in 2014 to 46,700 in 2016. Many of these refugees have young families and the number of child refugees has increased accordingly. Although child refugee health care has been in the forefront of media and medical attention recently, there is limited data on injury patterns in this population. Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) collects data on injuries in children presenting to the emergency department (ED). Our objective is to examine the clinical presentations and outcomes of refugee children with injuries presenting to a tertiary care paediatric ED. Methods: Our paediatric hospital has approximately 70,000 ED visits per year of which 13,000 are due to injuries and/or poisonings. The CHIRPP database was accessed to identify children with injuries presenting to our ED from April 2014 to March 2017 with Interim Federal Health Program (IFHP) registration status. All patient charts were reviewed to extract demographic and clinical care information. Results: There were 74 children with 81 ED visits during the study period of whom 19% were transferred from other facilities. Most of them (72%) were males with a mean age of 8.7 years (standard deviation 4.29). There were significant medical histories in 32% of children. The presentation to our ED (greater than 24 hours post-injury) was seen in 25% of visits. Twenty five percent of injured children were seen in our ED. The distribution of Canadian Triage Acuity Score (CTAS) scores 1, 2, 3, 4, and 5 were 0%, 16%, 37%, 46% and 1% respectively. However, subspecialty consultations were required in 69%, 60% and 27% of CTAS 2, 3 and 4 children respectively. Overall, 46% of all patients required subspecialty consults. The top three categories of injuries include fractures (23%), soft tissue injuries (20%) and lacerations (17%). More than half (56%) required diagnostic imaging. Most (89%) were treated in ED and discharged (average length-of-stay 3 hours 55 minutes) and 11% required admissions. 47% of children lacked primary care physicians. Conclusion: Almost half of refugee children with IFHP status require DI testing, sub-specialty consultations and primary care referrals when presenting to our ED with injuries. Follow up arrangements are needed as many do not have access to primary care providers. This demonstrates a need for securing primary care providers early for this vulnerable population.

Reducing Health Services for Refugees Through Reforms to the Interim Federal Health Program

Since 1957 the Interim Federal Health Program (IFHP) has provided temporary health care coverage to refugees and refugee claimants, but in 2012 the Conservative government reformed the IFHP, reducing, or eliminating access to health services for these groups. The government framed the changes around fairness and safety, stating that it would save tax payers $100 million over five years, reduce incentive for migrants with unfounded refugee claims from coming to Canada, protect public health and safety, and defend the integrity of the immigration system. With a Conservative majority, the reform was easily implemented despite a lack of evidence supporting these claims. In 2014, the Federal Court rejected the government's notion of fairness and safety, ruling that the cuts were cruel and unusual treatment of an already vulnerable population. The government appealed this ruling but, in 2016, the Liberals took power and restored funding to the IFHP to pre-2012 levels. Ad hoc evaluations predicted inequitable and adverse impacts on refugees, negative impacts on health, and increased costs to refugees, provincial governments, and health providers. Overall the threats and weaknesses of this reform clearly outweighed the few and unconvincing opportunities and strengths of the program, leading to its demise. Depuis 1957, le Programme federal de sante interimaire (PFSI) offre une protection en matiere de soins de sante temporaires aux refugies et aux demandeurs d'asile. Neanmoins en 2012, le gouvernement conservateur a revise le PFSI afin de reduire ou eliminer l'acces aux services de sante pour ces groupes. Le gouvernement conservateur a presente cette reforme au nom des principes d'equite et de securite, en affirmant qu'elle ferait economiser 100 millions de dollars en cinq ans, tout en preservant l'integrite du systeme d'immigration. Il soutenait que cette reforme budgetaire decouragerait les fausses demandes d'asile et protegerait la securite nationale et la sante publique. A l'epoque ou le gouvernement conservateur avait la majorite, la reforme a rapidement ete mise en place, malgre un manque de preuves credibles des affirmations. En 2014, la Cour federale a rejete la notion de d'equite et de securite du gouvernement et juge que ces coupes budgetaires pouvaient etre considerees comme une peine cruelle et inusitee a l'encontre d'une population deja vulnerable. Le gouvernement conservateur a ensuite fait appel de cette decision de la Cour federale, mais les Liberaux, arrives au pouvoir en 2016, ont finalement pu remettre en place le financement du PFSI. Des evaluations ad hoc de cette reforme ont predit des impacts inequitables et negatifs, non seulement sur les refugies (consequences negatives sur la sante et augmentations des couts de la vie), mais aussi sur les gouvernements provinciaux et les fournisseurs de sante. Finalement, les menaces et faiblesses clairement identifiees de cette reforme l'emportaient sur les possibilites et avantages peu convaincants, menant ainsi a sa disparition.

Borderzones and the politics of irregularisation: the Interim Federal Health Program and Toronto's everyday places of healthcare

Engaging with the concept of borderzones, this article critically analyses the irregularisation of refugee claimants residing in Toronto, Ontario, Canada. Specifically, attention is placed on the Interim Federal Health Program (IFHP), a federal health insurance program provided to refugee populations, and how it was experienced in everyday healthcare places. Drawing on semi-structured interviews with doctors, lawyers, social workers, and refugee claimants, this article empirically demonstrates irregularising bordering practices within these everyday places, and how refugee claimants and allies challenged such practices through, what I term, acts of liberating irregularity. Overall, this article sheds new light on the role of borders in the processes and politics of irregularisation within the Canadian asylum context.

Borderzones and the politics of irregularisation: the Interim Federal Health Program and Toronto's everyday places of healthcare

Engaging with the concept of borderzones, this article critically analyses the irregularisation of refugee claimants residing in Toronto, Ontario, Canada. Specifically, attention is placed on the Interim Federal Health Program (IFHP), a federal health insurance program provided to refugee populations, and how it was experienced in everyday healthcare places. Drawing on semi-structured interviews with doctors, lawyers, social workers, and refugee claimants, this article empirically demonstrates irregularising bordering practices within these everyday places, and how refugee claimants and allies challenged such practices through, what I term, acts of liberating irregularity. Overall, this article sheds new light on the role of borders in the processes and politics of irregularisation within the Canadian asylum context.

The gap between coverage and care-what can Canadian paediatricians do about access to health services for refugee claimant children?

In June 2012, the government of Canada severely restricted the scope of the Interim Federal Health Program that had hitherto provided coverage for the health care needs of refugee claimants. The Quebec government decided to supplement coverage via the provincial health program. Despite this, we hypothesized that refugee claimant children in Montreal would continue to experience significant difficulties in accessing basic health care. (1) Report the narrative experiences of refugee claimant families who were denied health care services in Montreal following June 2012, (2) describe the predominant barriers to accessing health care services and understanding their impact using thematic analysis and (3) derive concrete recommendations for child health care providers to improve access to care for refugee claimant children. Eleven parents recruited from two sites in Montreal participated in semi-structured interviews designed to elicit a narrative account of their experiences seeking health care. Interviews were recorded, transcribed, coded using NVivo software and subjected to thematic analysis. Thematic analysis of the data revealed five themes concerning barriers to health care access: lack of continuous health coverage, health care administrators/providers' lack of understanding of Interim Federal Health Program coverage, refusal of services or fees charged, refugee claimants' lack of understanding about health care rights and services and language barriers, and four themes concerning the impact of denial of care episodes: potential for adverse health outcomes, psychological distress, financial burden and social stigma. We propose eight action points for advocacy by Canadian paediatricians to improve access to health care for refugee claimant children in their communities and institutions.

Impacts of the Interim Federal Health Program reforms: A stakeholder analysis of barriers to health care access and provision for refugees.

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.