Citizenship and Immigration Committee on Oct. 24th, 2017

[Michael MacKinnon]

No, there have not.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thank you.

I'm wondering if you could also provide a breakdown by year over the last 10 years, in terms of the types or classifications of either diagnoses or symptoms that have been used to deem someone medically inadmissible, by number of cases. If you don't have that data here, could you provide it to committee?

[Michael MacKinnon]

We will provide that data.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thank you.

The other component that I wanted to touch upon was the figure of $135 million over five years. Rather than a perspective on cost over five years, could you provide the committee with the cost-benefit analysis of it by fiscal year going forward, based on your analysis? I just want us to have an exact cost breakdown by fiscal year, if there was a replication of this policy, of what the actual cost would be. Also, what assumptions have you made in terms of the input costs to get to that figure?

[Michael MacKinnon]

The input costs in terms of the amount of effort by the department were relatively low.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Sorry; to be clear, what I'm asking you to table with committee is a forecast. Just to clarify, in your cost-benefit analysis, how many years did you forecast into the future right now?

[Michael MacKinnon]

We used one year of representative data in order to conduct the cost-benefit analysis, and the determination is based on a five-year cost estimate. We used those cost estimates as the basis for the savings.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Okay, so based on that analysis, could you provide two figures for the committee? I'm interested in, by year, the cost that you're projecting if this policy continues, and then how you came to that figure.

I'm not asking for your time to be calculated; I'm asking for costs to provincial health care systems, medical costs, anything, just so that as committee members we can get a sense of what costs are associated with this analysis.

[Michael MacKinnon]

The approximately 900 cases were reviewed by an analyst to identify the estimated cost savings from each of those cases, and we summed that up as being the estimated cost savings to provinces for that year. Given that we were using a year that had roughly balanced numbers in terms of the different types of conditions that were under consideration, our assumption would be that for each year of decisions, you would generate approximately that same order of magnitude of savings, so $120 million to $150 million per year, as you sum that out over each year of decisions.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

In terms of other assumptions you put into that figure, are you assuming other inputs such as the amount of taxation somebody might pay when they come to the country? Are you looking at any net economic benefit in terms of costing that out as well, or is it just the figures around what their potential costs to the health care system would be?

[Michael MacKinnon]

It is straight-up avoided costs for the health care systems. Net economic benefit would have been too complex to undertake in the analysis.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Can you also provide us with a breakdown by country, let's say over the last 10 years, of how many cases are rejected due to medical inadmissibility?

[Michael MacKinnon]

We will get that data.

[Dawn Edlund]

Just to clarify, Mr. Chair, is that by the nationality of the applicants?

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Yes.

Can also you provide us with a bit of background on how doctors are selected to take part in these exercises—how the department would source physicians?

[Dawn Edlund]

I'll start, and then I'll refer to Dr. Saeed.

I referred in my opening remarks to what are called “panel physicians”, who are empanelled by the department according to a set of different standards. We do quality assurance and various checks on those medical professionals to make sure they're going to do the immigration medical exam under the standards we set out for them. We also have our own medical officers, who are departmental staff, who do the actual assessment.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Is there a certification or quality assurance process that the department uses?

[Dawn Edlund]

Do you mean for the panel physicians? Absolutely. We monitor the activities—sometimes in combination with a country like Australia, because we share some of the same panel physicians—to make sure they're doing things as they're supposed to. If there are instances of serious problems, we no longer allow them to be our panel physicians.

[The Chair, Liberal, Rob Oliphant]

Thank you very much.

Just before we go to Ms. Kwan, could I clarify one thing that has come up in both rounds of questions? In your opening remarks, you state costs on the order of $135 million over five years, for each year of decisions. That language is eluding me, because it says two different things. It says $135 million aggregated over five years, but then it says “for each year of decision”, and Mr. MacKinnon's remarks just seemed to indicate it was $135 million a year. I'm trying to understand that.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

As a point of clarification, Mr. Chair, thank you for raising this. I just want to clarify the data I was trying to get out of the witnesses. We have the same concern, so if it's $135 million over five years, but it's a rolling scale, what is the actual cost per year? That would be a more meaningful figure.

[The Chair, Liberal, Rob Oliphant]

That's what I'm trying to understand, because I don't understand the syntax of that sentence.

[Michael MacKinnon]

Thank you, Mr. Chair, and to be clear, it is that each year of decisions in essence generates a five-year profile of avoided costs for the provinces. Because it involved a case-by-case review by an analyst in order to conduct the cost-benefit analysis, we used only one year, which was an exemplary year in terms of the levels of immigration, all the source countries, and those sorts of things.

We're using that as the assumption that savings will be, for each year of decisions, on the order of $135 million over that five-year period of time, but then each subsequent year of decisions will generate a similar five-year profile of savings in turn, as Ms. Rempel indicated.

[The Chair, Liberal, Rob Oliphant]

It is difficult for us, because why is it five years and not 10 years or 20 years? It would seem to me that a year of decision would be one-fifth of that amount per year, but it could be 25 years, or four years, or two years, or the person could die in six months.

[Michael MacKinnon]

We used a five-year profile because that is the basis of the policy, which is that the assessment is done using the estimated costs over a five-year period for an individual's given health condition.

[The Chair, Liberal, Rob Oliphant]

Would it be fair to say $27 million a year for maybe five years, or not?