Y.Y. Brandon Chen is faculty at the University of Ottawa in the Common Law section of the Faculty of the Law. Emilie Azevedo sat down with Professor Chen to talk about gaps in the healthcare Canada offers immigrants and refugees, and how the law might be used in working to address them.
We’d like to think that Canada has a universal healthcare system. Common Law Professor Yin Yuan (Y.Y.) Chen studies how this is not exactly the case. In fact, many people who live in Canada would not be considered residents for the purpose of publicly funded healthcare.
Professor Chen researches the legal, policy and ethical aspects of international migration and health, specifically migrant rights to healthcare. By comparison with how other countries deal with these issues, he identifies gaps in the way services are delivered in Canada.
For example, international students who attend universities in Ontario are required to subscribe and pay into a program called University Health Insurance Plan (UHIP). Such privately paid insurance can be challenging. Users must pay premiums for specific services. Oftentimes they are required to pay out of pocket before being reimbursed. Private insurance companies can also deny services to people with preexisting conditions.
That being said, there are different kinds of migrants, and their experiences with healthcare are not all the same. Asylum seekers—those who have fled their home countries to avoid persecution or harm—have their own healthcare program funded by the federal government called the Interim Federal Health Program (IFHP). But even this doesn’t come without its problems. For example, when patients try to use their federal coverage, either at the pharmacy or a doctor’s office, it is not uncommon for their insurance to be denied because some healthcare providers are not aware of or do not recognize the IFHP, leaving them out of pocket for their healthcare costs. This burden can be especially untenable for asylum seekers, who are so often in tremendously precarious positions.
Professor Chen seeks to know, as a society, what our normative stance toward migrants accessing healthcare is. He also dives into deeper questions: “Is it legitimate for a government to deny healthcare to a certain group of people based on their immigration status?” And, “If we don't provide healthcare to those people, what may be the implications on public health?” This last question is especially relevant during a pandemic.
Assuming we can agree that some people are entitled to healthcare but excluded from the system, Chen explores legal solutions that might be used to bring a change in policy, whether it be the Canadian Charter of Rights and Freedoms or other avenues for litigation.
Professor Chen has witnessed positive outcomes from advocacy efforts that he is part of. Notably, by having regular conversations with Immigration, Refugees and Citizenship Canada, Chen and his colleagues have seen the government expand or change some of the policies related to the IFHP. For instance, in recent years the IFHP expanded the range of mental health service providers that it covers to include social workers, relieving a bottleneck that had existed up to then.
In the future, Chen would like to see greater appreciation in our policymaking for migrants as residents. “We should look beyond the legal labels that people have in terms of their status and maybe see how long they have lived here, what kind of social networks they have built here, and what kind of work they have been engaged in,” says Chen. In his opinion, using these types of markers would be “an ideal way to figure out who should get healthcare and ensure that all people who truly reside in Canada are provided healthcare”.
Professor Chen has been teaching at the University of Ottawa since 2016. One of the most rewarding aspects of his job is being able to interact and problem-solve with his students. Through his research he has had the opportunity to interview a variety of people. Many of the nurses, doctors and other healthcare professionals he has spoken to are passionate about providing healthcare to all patients, regardless of insurance status. It’s this kind of human interaction that drives him at the end of the day.
On the other hand, this kind of work can feel like shouting into the abyss. Professor Chen and his colleagues don't always see the outcomes of their work right away. They are constantly crafting new ways to deliver their research and proposals for reform so that they can receive more buy-in from the government and from society at large. But as Y.Y. says, “What’s life like without a challenge?”