Evidence-informed criteria for assessing medical inadmissibility in Canadian immigration law
(OHTN 2008 Research Conference Abstract)
- Peter Coyte, PhD, University of Toronto
- Michael Battista, Barrister and Solicitor, Jordan Battista LLP.
- Ahmed Bayoumi, MD, University of Toronto
- Alan Li, MD, Regent Park Community Health Centre
- Dave Holmes, RN, PhD, University of Ottawa
- Richard Elliott, Canadian HIV/AIDS Legal Network
- Sandra Chu, Canadian HIV/AIDS Legal Network
- Francisco Rico-Martinez, FCJ Refugee Centre
The Immigration and Refugee Protection Act (IRPA) outlines the conditions under which individuals may be denied admission to Canada. Section 38(1) stipulates that applications for residence may be rejected if the applicant’s health is likely to generate “excessive demand” on Canadian health or social services. This project derives a compelling statistical definition of excessive demand and applies this threshold to persons with HIV/AIDS seeking admission to Canada.
There are five components to this project:
- We review the application of Canadian immigration law as it pertains to persons with HIV/AIDS in the context of international HIV-related mobility restrictions.
- We review and assess the current threshold used to determine excessive demand on Canadian health or social services.
- We synthesize the clinical, epidemiological and economic literatures regarding the expected burden placed on health or social services by persons with HIV/AIDS.
- We derive estimates of the economic burden associated with a new immigrant with HIV/AIDS over a 5-year, 10-year and lifetime horizon after stratifying for their state of health, sex, and age at admission.
- Estimates of economic burden are compared to the excessive demand threshold to yield evidence-informed criteria for assessing medical inadmissibility.
Three substantive findings:
- The current cost threshold used by Citizenship and Immigration Canada (CIC) in assessing whether an applicant is likely to pose “excessive” demand (C$4,867.40/year) is too low. A statistically more appropriate threshold is three-fold greater at C$14,581.43/year.
- There is a close relationship between disease progression (measured by CD4+ cell counts) and health care costs, with annual costs of about C$12,000 for CD4+>200/μL, C$18,000 for CD4+ from 51-200/μL, and C$30,000 for CD4+<50/μL.
- Application of these cost estimates to the revised cost threshold for inadmissibility indicates that classification depends on individual characteristics, including age, sex and health status, as well as on the time horizon over which each applicant’s projected demand is assessed. “Excessive” demand is more likely to occur for applicants with low CD4+ cell counts and a shorter time horizon for assessment (i.e., 5-years versus their lifetime). Women and younger applicants are slightly more likely to be deemed inadmissible than men and older immigration applicants.
Impact on Policy and Practice:
CIC should develop more evidence-informed policy and admit to Canada some applicants otherwise denied admission based on current policy.