World Refugee Day, observed annually on June 20, this year highlighted the theme, “Until Everyone Is Safe.” It renewed attention to policies that shape the health and well-being of refugees during settlement.
In Canada, recent changes to the Interim Federal Health Program (IFHP), introduced in May 2026, have renewed concerns about financial barriers to healthcare. The changes include new out-of-pocket costs, such as a $4 prescription fee and a 30 per cent co-payment for supplemental health services.
While these charges may appear modest, years of health research demonstrate that even small user fees can reduce healthcare utilization among low-income populations. For refugees and newcomers – navigating displacement, settlement, income security and housing challenges – even small costs may create additional barriers to necessary care. care.
The IFHP and policy reforms
The IFHP provides temporary health coverage for refugees, protected persons and refugee claimants who may not yet qualify for provincial health insurance. It is a transitional safeguard to support access to essential healthcare during early settlement or while their status is being determined.
Coverage includes both basic services (physician visits, hospital care, diagnostic testing) and supplemental services such as prescription medication, dental and vision care, counselling and assistive medical devices.
Access challenges have long existed within the program. Many supplemental services, for example, require physician referrals and pre-authorization, meaning that eligibility does not always translate to timely care.
The IFHP has also undergone significant policy changes in the last 15 years. In 2012, changes included reduced coverage for many refugee claimants, eliminating access to numerous supplemental benefits and introducing a tiered system based on immigration status and country of origin. Wellesley Institute’s Health Equity Impact Assessment at the time concluded the reforms would likely increase health inequities and disproportionately affect refugees with greater health and social needs.
The reforms were widely contested and, in 2014, were ruled partly unconstitutional by the Federal Court of Appeal. Full coverage was ultimately restored in 2016.
The introduction of new co-payments in 2026 has therefore reopened longstanding debates about the role of financial barriers to refugee healthcare coverage.
Co-payment models can limit access
Research consistently shows out-of-pocket costs influence whether or when people seek care. Patients reduce their use of healthcare services when user fees increase, including services considered medically necessary. These effects tend to be greatest among people with low incomes and those managing chronic or complex health conditions.
For refugees and refugee claimants, these findings are especially relevant. Newcomers often experience higher rates of unmet healthcare needs during the settlement period while simultaneously navigating employment challenges, language barriers, housing instability and trauma-related health concerns. In this context, services categorized as supplemental are often integral to maintaining health.
Research conducted at SickKids found increased hospitalizations following the 2012 IFHP cuts, as care that would previously have been publicly funded was shifted onto hospitals. Healthcare and advocacy organizations, including the Canadian Medical Association, Canadian Paediatric Society and Amnesty International, among other healthcare practitioners, have warned that restricting access to preventative and community-based care can lead to delayed treatment and more severe health needs later.
Broader system and equity considerations
Access to primary care and preventive services is associated with better health outcomes and reduced reliance on costly acute care services. Conversely, barriers that delay access can contribute to worsening health conditions and more complex care needs over time.
Financial barriers disproportionately affect people already experiencing socioeconomic disadvantages. Refugees and newcomers often experience intersecting forms of vulnerability, and additional healthcare costs can pose major barriers to accessing services that would otherwise be necessary to support their settlement experience.
The World Refugee Day theme, “Until Everyone Is Safe,” serves as a reminder that safety includes access to essential healthcare during resettlement.
The history of IFHP is an important reminder that reductions in healthcare coverage can lead to negative impacts for equity-deserving populations. As co-payments are reintroduced, monitoring will be needed to understand their effects on health equity and access for refugees across Canada.