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Excessive Demand Cost Threshold

The Immigration and Refugee Protection Act (IRPA) and the Immigration and Refugee Protection Regulations (IRPR) outline the health inadmissibilities for immigration to Canada. Paragraph 38(1 )(c) of IRPA states that: "A foreign national is inadmissible on health grounds if their health condition might reasonably be expected to cause excessive demand on health or social services." Subsection 1(1) of the IRPR defines excessive demand, health services and social services.

Each applicant is assessed on an individual basis. When determining whether an individual is likely to cause an excessive demand, a medical officer employed by the Department of Citizenship and Immigration Canada (CIC) compares the costs of anticipated publicly funded health or social services for that individual against the Canadian per capita average over a period of five consecutive years from the date of the person's most recent immigration medical examination. However, in cases where there is evidence that significant costs are likely to be incurred beyond that period, the period is no more than 10 consecutive years.

The officer also assesses whether the anticipated health or social services requirements would add to existing waiting lists, and would increase mortality or morbidity in Canadian citizens or permanent residents as a result of the prevention or delay of the provision of those services.

The combined average per capita cost of health and social services in Canada is the "excessive demand cost threshold." When calculating whether a person exceeds this threshold, the CIC medical officer multiplies the average Canadian per capita health and social services costs by the number of years used for the medical assessment window of the individual applicant.

To calculate the dollar amount of the health services component of the excessive demand cost threshold, CIC uses the Canadian Institute for Health Information's (CIHI) figure on per capita costs for health services. CIHI updates this information annually and publishes it in their document "Health Care in Canada," available on their website at www.cihi.ca.

The CIHI figure is under-inclusive as per the definition of excessive demand in the IRPR as it does not fully capture the per capita costs of publicly-funded social services. Social services are included under excessive demand because they represent an important component in the management of certain health conditions.

The IRPR defines “social services” as:

any social services, such as home care, specialized residence and residential services, special education services, social and vocational rehabilitation services, personal support services and the provision of devices related to those services that are intended to assist a person in functioning physically, emotionally, socially, psychologically or vocationally; and for which the majority of the funding, including funding that provides direct or indirect financial support to an assisted person, is contributed by governments, either directly or through publicly-funded agencies.

To calculate the dollar amount of the social services component of the excessive demand cost threshold that is not captured in the CIHI figure, CIC has used information from Statistics Canada, provincial governments, and the Canadian Home Care Association.

CIC's Health Management Branch updated the excessive demand cost threshold effective December 1,2008 to comply with departmental legislation. The new cost threshold is $5,143 and replaces the previous threshold of $4,806 (from December 2007). This new threshold amount was calculated by adding the 2008 CIHI figure of $4,867 to the new amount for social services that was calculated as $276.

*Information taken from CIC via CMI

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