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3-month waiting period for healthcare coverage means worse health outcomes, stigma for new immigrants: study

BC’s policy of requiring new immigrants to undergo a three-month waiting period before they can receive provincially-funded healthcare is xenophobic, and leads to mistrust and worse health outcomes for newcomers—those are some of the findings in a new study published in renowned medical journal The BMJ.

The paper, written by researchers from SFU and UBC, said the impacts of the “arbitrary” three-month waiting period for Medical Services Plan (MSP) eligibility were particularly severe for racialized women and children.

Waiting period delays costs, rather than saving them

“Participants in the study described especially alarming experiences of being denied care during pregnancy, as well as not being informed about options for care,” said Dr Shira Goldenberg with the UBC Centre for Gender and Sexual Health Equity.

“It also means that the cost is borne down the road, when people present with more significant issues. … We interviewed participants who didn’t receive prenatal care interests till the very last weeks of pregnancy, for example, as a result of this policy.”

Goldenberg called the idea that new immigrants are immediately going to the doctor to receive unnecessary or expensive healthcare a “misconception.”

The waiting period, however, means people end up letting their conditions worsen over time until they are eligible for MSP—making them more expensive to treat, with the cost falling on MSP anyway.

Another problem, she said, is that there aren’t standardized costs for care delivered outside the MSP, meaning people don’t know how much services are going to cost them out of pocket.

“And this often resulted in really, really anguishing, harrowing decisions that families had to make—often between putting food on the table and having a roof over their head, or seeing a doctor for a sick child or going to the hospital for labour and delivery.”

Mistrust and stigma

Apart from the physical consequences of being denied care, Goldenberg said there were significant psychological impacts on new immigrants. The waiting period led to them feeling stigmatized and having mistrust in the system.

Participants reported experiencing racist and “loud and invasive” questioning at healthcare facilities by receptionists. The treatment they received made them feel as if they were under suspicion, and that providers who didn’t feel they “deserved” healthcare had the power to decide “who can access healthcare and who can die.”

“Participants perceived it as a really significant form of xenophobia. They simply could not understand why they were being singled out for not being able to access basic services, while others around them clearly were,” Goldenberg told the Beacon.

“And this resulted in feeling unwelcome and unwanted in British Columbia; it made people feel that their needs and their lives didn’t matter as much as others around them who are born in Canada.”

Omar Chu, who’s a member of health collective Sanctuary Health based in Vancouver, agreed—calling the impact on newcomers “terrible.”

“It’s incomprehensible and shocking after fighting for so long to become permanent residents, or for example, babies who have always been citizens of Canada, to have public healthcare denied for three months,” he said.

Babies denied care

Babies born in Canada are still subject to BC’s three-month waiting period if their parents don’t have medical coverage here—and participants reported the “devastating” consequences of that situation in the study.

“One family spent their last few hundred dollars on a doctor’s visit and medication for their sick child, leaving them with nowhere to sleep and little money for food,” the study reads.

“My daughter would cry from pain. I would cry with her until the morning. … The doctors were refusing to see her. What if something happens to my daughter? Coming to Canada had become a negative experience for me because I was worried about losing my daughter. … I’ve faced so much hardships and continue to face hardships,” another woman told researchers.

Other women described experiencing miscarriages during pregnancies where they couldn’t receive care and the difficulty of securing private insurance, with pregnancy often viewed as a “pre-existing condition.” Meanwhile, families were worried during labour about how they would be able to afford their delivery—and, in some cases, even left the hospital before they were ready.

The study said women called their experiences “shocking” in comparison to their home countries, especially when they had expected Canada to have a much more inclusive system.

Calls to end the waiting period

At the beginning of the COVID pandemic last year, BC suspended the waiting period to allow people to safely seek medical care. But it was reinstated less than 6 months later, for what Goldenberg said were “economic reasons.”

Goldenberg, and Sanctuary Health, are calling on the province to immediately scrap the three-month waiting period policy on a permanent basis. The Centre for Gender and Sexual Health Equity has also started a petition for the same.

We’ve reached out to the Ministry of Health for comment.

Goldenberg told the Beacon this is an opportunity for the government to make good on its verbal commitments around promoting equity in the healthcare system.

“I don’t think it aligns with the purported values of who we think we are, as a society and in British Columbia,” she said.

“And I think that this is really an area where the government could take significant action.”