Equity Means Access

HEALTH CARE FOR ALL Sanctuary Health collective volunteers Maria Paralta and Natalie Blair believe all people, regardless of legal status, have the right to health care without fear.

Nurses and others welcomed the provincial government's elimination of Medical Service Plan (MSP) monthly premiums at the beginning of 2020. It was a positive step to provide barrier-free access to health care in the province, replacing a punitive and regressive tax on care.

But advocates say further improvements are needed to ensure that the delivery of health care in BC is truly fair. One of these would be the removal of the three-month wait period.

At present, BC is one of only three provinces – the others are Ontario and Quebec – that deny up to three months of health coverage to people arriving or returning from outside of Canada. This exclusionary wait period prevents new immigrants, temporary foreign workers, returning Canadians and even some newborn Canadian babies from receiving needed health-care coverage.

Sanctuary Health is one organization that's urging the provincial government to end the mandatory wait period. The grassroots community group is a collective of health-care and community workers who advocate for access to services for all, regardless of immigration status or documentation.

"The journey of migration puts people in a place of significant vulnerability," says Sanctuary Health collective member Natalie Blair. "And to then be barred access to care means they delay seeking help for their health concerns."

According to the BC government, the wait period protects the province's health-care system by reducing the likelihood of individuals coming to BC for the purpose of receiving health-care services at public expense.

Blair disagrees with the government's rationale. A BCNU member and nurse practitioner student who has worked in the community for over 10 years, she's seen the harm the policy has caused.

She knows that most new immigrants, temporary foreign workers and even returning Canadians will delay accessing care. This is evidenced by the spike in physician billings in the fourth month of an immigrant's stay, demonstrating that delaying care leads to greater potential system-wide costs as illnesses progress and advance.

BCNU member Sarah Reaburn is a nurse who's working to improve health access for migrant, immigrants and refugees who may be unsure or fearful of accessing health care in a new country. She has worked at Vancouver's Elizabeth Bagshaw Clinic, BC Women's Hospital and the BC First Nations Health Authority.

During the course of her nursing and midwifery work, Reaburn reports seeing people without MSP coverage struggle to access preventive care during their pregnancy due to an inability to pay or a fear of deportation. Often clients delay accessing care until later in their pregnancy or illness, or they may opt out of tests they can't afford. She says this is stressful for both patients and nurses, many of whom are already experiencing high rates of burnout.

"There is moral injury and moral distress that's put on nurses, physicians and midwives and all of the front-line health-care workers who are trying to patch together what they know is insufficient care," says Reaburn. "Providing less-than-standard care to people causes a huge amount of burnout and also costs the system a lot more."

Blair explains that if immigrants and migrants from other provinces do choose to access care before their MSP coverage starts, they are encouraged by the government to purchase private health insurance. But she says that is unaffordable for most.

"All people, regardless of immigration status, deserve dignified access to care and a place in the community," she argues.

Blair reports that Sanctuary Health recently submitted a policy study and letters supporting the organization's position to the BC Medical Services Commission, the statutory body tasked with ensuring that all BC residents have reasonable access to care.

And in December 2021, the organization partnered with UBC's the Centre for Gender & Sexual Health Equity to send an open letter to the BC government sharing new research supporting the immediate repeal of the wait period.

The research evaluated the impacts of a residency-based wait period for health insurance coverage on lived experiences of health and settlement for immigrant and migrant women in BC. Conducted in the Metro Vancouver area from July 2018 to January 2020, researchers collected data from community focus groups made up of service providers, and racialized immigrant and migrant women.

According to the study, the wait period resulted in mistrust and internalized stigma for the research subjects, who reported feeling undeserving of care.

The study also found that participants were confused as a result of being uninformed about the wait period prior to arriving in Canada, and they struggled with the paperwork. This led to the delay of care, particularly related to sexual and reproductive health and children's health.

Community-based organizations could provide support in many areas but could not fill all gaps produced by the wait period, the report found.

BCNU was one of the organizations that endorsed last December's open letter to the government. The union supports the call to end the wait period as part of its belief that all people in the province deserve access to high quality health-care services whenever they need them.

"By removing the wait period, the government could help ensure all people in the province are treated equally and with respect, no matter when they arrived," says BCNU Vice President Adriane Gear.

Blair says there is a precedent to remove the three-month wait period, noting that in 2007 BC waived the wait period for MSP coverage for Canadian military families moving to BC from overseas. She also points to the principles that are the foundation of the Canada Health Act, and which govern provincial public health insurance systems. One of those principles – accessibility – is clearly breached by the wait period, she argues.

In the meantime, Blair and Reaburn encourage other nurses to be vocal about their commitment to their patients and want to remind them about the importance of nurse advocacy and focusing on the social determinants of health.

The two are exploring opportunities to host workshops on issues surrounding the provision of care to for people without health coverage. Reaburn says it's a complex and nuanced topic and admits there is a range of opinions.

"Part of our role as nurses is to encourage systemic change that will ensure the best quality of care for all patients," she says.•

UPDATE (Spring 2022)