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When is Someone Inadmissible?

ENF 2/OP 18 Inadmissibility:

  • When an officer is of the opinion that a foreign national may be a member of an inadmissible class described in subsection 38(1) of the IRPA, the officer may require persons described within the provisions of R30 to undergo a medical examination;
  • Conditions may be imposed pursuant to Reg. 32 requiring the person to report at a specified time and place for a medical examination and to provide proof, at a specified time and place, of compliance with the conditions imposed;
  • Medically inadmissibility results from the opinion of the officer following his / her:
    • observation: the person may appear to be sick or may require assistance, and
    • questioning: has the person recently been discharged from hospital? Has the person recently been sick? Is the person taking medication for a serious illness?
  • Pursuant to regulation 29 and for the purposes of paragraph s. 16(2) (b) of the IRPA, a medical examination includes any or all of the following:
    • a physical examination
    • a mental examination
    • a review of past medical history
    • laboratory tests
    • diagnostic tests
    • a medical assessment of records respecting the applicant

Reg. 30(4) provides: every foreign national referred to in Reg. 30(1) who seeks to enter Canada must hold a medical certificate that indicates that they are not inadmissible on health grounds and that is based on the last medical examination to which they were required to submit within the previous 12 months.


Action at international airports

  • Where it is believed that a person may be medically inadmissible at an international airport, normally, after consultation by telephone with a medical officer with the Immigration Medical Services Division, the examination should be adjourned under the provisions of s. 23 IRPA.
  • The person would then be required to undergo a medical examination pursuant to reg. 30(1) (d) by a Panel Physician in Canada.
  • Officers must ensure they impose appropriate conditions as allowed for under reg. 32 in addition to those conditions that must be imposed pursuant to reg. 43(1); that is, that the person is required to report at a specified time and place for a medical examination and is to provide proof, at a specified time and place, of compliance with conditions imposed.
    • Officers are to make every effort to make the appointment for the person. All appointments should be scheduled for the earliest possible date.

In Canada, health care coverage is under the direction of the individual provinces and only regulated and partly funded by the federal government. Medically required services are covered in full by the beneficiary’s home province; however outpatient prescription drug costs are not necessarily covered. Each province has specific criteria indicating who can be reimbursed and for how much. The difference in the amounts of coverage provided by each province and the extent of this variation conflicts with the notion of equally distributed health care and costs for would be applicants to Canada. As such, it is also evident that those wishing to immigrate to Canada would potentially cost different amounts of money to the government depending on which province they assume residence. By examining provincial drug reimbursement programs it is possible to more appropriately understand the significance of these differences.

The proportion of health care costs attributable to medications has increased dramatically over the last two decades as evidenced in the next two figures

http://www.hc-sc.gc.ca/hcs-sss/pubs/pharma/2006-nps-snpp/index_e.html

The following two figures from The Canadian RX Atlas demonstrate the complexity of calculating drug costs in each province as well as the significant inter-provincial differences.

http://www.cmaj.ca/content/vol178/issue4/images/large/17FF1.jpeg

Included here is an example of one of 4 clinical scenarios featuring simulated patients created for the purpose of the CMAJ study. The calculated totals include professional fees and all figures are represented in Canadian dollars.

http://www.cmaj.ca/content/vol178/issue4/images/large/17FF1.jpeg

Interpretation of these results yields the observation that seniors are extensively covered compared with other groups but with significant variation within this group between provinces. Non-seniors pay higher percentages of their costs; however discrepancies across provinces are substantially less than for the senior group.

One of the guiding principles of the Canadian health care system is that all Canadians should have similar access to the same health care benefits and services. As of now Canadians with the same needs pay significantly different amounts in different provinces. It is evident from various studies that health is compromised when access to prescription drug therapy is limited. This means that savings on the cost of prescription drugs by provincial governments could be offset by increased costs of caring for individuals whose health status has deteriorated because they could not access appropriate drug treatment. These increased costs could be the result of increased number of medical visits, increased number of investigations, increased hospitalization and increased use of community health care services. It is evident that access to prescription drugs varies significantly across provinces for those individuals who do not have private insurance plans or can afford to pay for their medications directly, resulting in significant differences in health care costs and in turn who might be inadmissible to Canada!


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