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New migrant health and disability screening rules

28 January 2004 Media Statement

New migrant health and disability screening rules

A new and enhanced immigration health and disability screening programme will be phased in this year, Immigration Minister Lianne Dalziel announced today.

The new screening regime follows the first comprehensive review of existing immigration health screening policies, Lianne Dalziel said.

"The New Zealand Immigration Service (NZIS) and the Ministry of Health will begin phasing in the new health and disability screening requirements from March 2004. We expect that the new screening requirements will be fully implemented by the end of this year," she said.

"These changes reflect the international environment in which New Zealand operates. With the increasing numbers of travellers visiting New Zealand and increasing numbers of foreign students it is important to ensure that our publicly funded health and education systems are not adversely affected."

The new programme boosts existing screening measures. More people wanting to enter New Zealand, will have to undergo tuberculosis (TB) screening particularly if they are from or have recently lived in identified countries with a high incidence of TB.

"This includes countries with more than 20 cases of TB per 100,000 of population and countries where the TB notification rate is likely to be inaccurately low due to poor diagnosis and notification."

At present only people planning to be in New Zealand for two or more years must be screened for TB. Under the changes, TB screening requirements will apply from March 2004 to students wanting to stay in New Zealand for more than six months, and from mid-2004, to visitors and workers intending to stay for longer than one year.

"By the end of 2004 it is intended to extend compulsory TB screening to all people wanting to enter New Zealand for six months or more, from high-risk countries."

"In addition, the new policy will require all people coming to New Zealand for 12 months or more, to undergo a full medical examination.

"The medical examination will test for a range of ill health and disability indicators, but has been expanded to include screening for HIV, Hepatitis B and significant kidney disease. It also allows for an assessment of likely costs to special education."

"The review has clearly identified the need to improve protection for the public against a highly contagious disease like TB. There were also issues related to people entering New Zealand while potentially needing treatment for such conditions as kidney failure or HIV/AIDS. The changes seek to off-set these risks.

In addition a flaw in the existing policy was that it did not identify disability unless there were associated costs to the public health system.

A new framework for assessing an acceptable standard of health includes three main components:

- screening for conditions that pose a public health risk.

- benchmarks to identify "significant" costs or demands plus a list of conditions that are above the benchmarks.

- professional support systems to ensure that NZIS medical advisers have access to speciality areas when assessing individual cases and for updates on disease and disability trends.

"Rules which previously allowed almost all residence applicants to apply for a waiver to the health and disability requirements have also been tightened.

"Now, only those who have close family links to New Zealand (ie, spouse, partner, parent, sibling, child), domestic violence category migrants and refugees will be able to be considered for a waiver.

Lianne Dalziel said she was pleased with the results of the review.

"Not only have we brought New Zealand's requirements more in line with countries like Australia and Canada, we have "future-proofed' the policy by providing that the Ministers of Health and Immigration can jointly agree to add or remove screening requirements in response to any changed circumstances."

Note: Question & Answer sheet attached.

For more information online: www.immigration.govt.nz or www.beehive.govt.nz/dalziel/

MIGRANT/REFUGEE QUOTA HEALTH AND DISABILITY SCREENING QUESTIONS & ANSWERS

January 2004

Q. What do these enhancements involve?

Currently, everyone seeking to enter New Zealand for two years or more (ie, not an existing New Zealand or Australian citizen or permanent resident) is required to undergo medical screening to ensure that they have an acceptable standard of health for immigration purposes. The enhancements involve extending the definition of "unacceptable standard of health", the number of conditions screened for, and the people who need to be screened.

1. Definition of "unacceptable standard of health"

The definition has been changed from "likely to be a danger to public health; or a burden on health services; or unfit for the purpose of entry to New Zealand" to "likely to be a danger to public health; or to impose significant costs or demands on health or social services, including education; or unable to undertake the functions for which they have been granted entry to New Zealand".

2. Public Health

From an immigration perspective, Tuberculosis (TB) is a major risk to public health in New Zealand. At present, all people aged 12 years and over seeking residence or temporary entry into New Zealand who wish to stay for two years or more are required to undergo TB screening before they arrive in New Zealand. Changes to the existing TB requirements include:

From March 2004

- TB screening for those seeking a student visa aged 11 and over who come from a country deemed to be at high risk of TB, or who have risk factors, and who intend to be in New Zealand for more than six months.

From mid-late 2004

- anyone aged 11 and over who comes from a high risk country and who intends to be in New Zealand for 12 months or more (as a resident, worker or visitor), will need to be screened offshore for TB before arriving in New Zealand.

By late 2004

- anyone aged 11 and over who comes from a high risk country and who intends to be in New Zealand for six months or more (as a resident, worker or visitor), will need to be screened offshore for TB before arriving in New Zealand.

Pregnant women and children under the age of 11 are exempt from this screening. This is on the basis of clinical advice regarding the balance of risk from exposure to x-rays.

3. Screening for expensive-to-treat conditions

"Significant" costs to the health system are defined as "likely to cost more than $21,000 over the next four years, or the expected life of the condition", and "likely" is defined as "70% probability or higher".

A child who would be eligible for entry to the special education Ongoing and Reviewable Resourcing Schemes would be considered to meet the threshold for "significant cost to education services".

There will be a progressive introduction over 2004 of compulsory screening for expensive-to-treat medical conditions, including HIV and Hepatitis B, and of the formal assessment of development (in children), and the likelihood of ongoing mobility and health dependency needs. This screening will apply to people seeking to be in New Zealand for more than 12 months, from late 2004.

People proposed for the Refugee Quota programme are currently screened for TB before travel to New Zealand; HIV screening will also be carried out for this group. A maximum of 20 HIV positive people will be accepted as quota refugees in any year.

4. Screening for ability to carry out functions for which applicants are seeking entry

"Unable to undertake the functions for which they have been granted entry" would mean, for example, that applicants are physically incapable of carrying out the employment they had been offered. This will involve an assessment of family-sponsored principal applicants who are intending to work, except where applicants are refugees, or have been sponsored for residence by refugees.

5. Waiver policy

At present, any applicant who is identified as not being of an acceptable standard of health may apply for a waiver of the health requirement. From mid-late 2004, waivers will only be available for people who are seeking residence on the basis of a family relationship to a New Zealander, or because they are a refugee.

As before, people needing kidney dialysis and those with active TB will not be able to be considered for residence. People with severe haemophilia applying for New Zealand residence will no longer be considered either.

6. Screening of family members

All children under the age of 16 (or 25 if financially dependent) will be required to undergo health and disability screening at the time of the residence application, whether or not they intend migrating at the same time as the rest of the family. This will be required regardless of whether the principal applicant or their partner has custody of the children at the time. Dependent children and partners will not be eligible for residence later, if the principal applicant did not include them in the original application, or gave false information about their state of health or disability.

This is an important change because there have been examples of applicants applying without non-eligible dependents included in the application, and then seeking humanitarian intervention for their non-eligible spouse/child.

Q. Why are these enhancements being made now?

Immigration health and disability screening requirements have never been comprehensively reviewed. Given that eligibility for publicly-funded health care was reviewed in 2003, and foreign students and visitors are now excluded, it is timely to introduce these changes now. The results of this review reflect the international environment in which New Zealand now operates - ie more travellers visiting New Zealand and an increasing numbers of foreign students living in New Zealand. We need to ensure that the New Zealand health system is able to support those people who are legally allowed to be here. It also means that our immigration health screening measures are in line with the screening policies of other countries such as Australia and Canada.

Q. What if other changes need to be made to health screening requirements in the future?

The policy has been "future-proofed" - a regular review process is being introduced and the Ministers of Health and Immigration will be able to jointly agree to add or remove screening requirements in response to any changed circumstances.

Q. What are the benefits to New Zealand of introducing these enhancements?

There are potential long term cost savings to health, education, and social services.

Q. When do these enhancements apply?

They will be phased in over 2004 with a number of implementation dates for changes to TB screening. From March 2004, the changes will apply for students from countries with a high incidence of TB or who have risk factors and who intend to be in New Zealand for more than six months. From mid 2004, all people entering New Zealand under temporary entry policy from countries with a high incidence of TB or who have risk factors and who intend to be in New Zealand for more than 12 months, will be required to have TB tests (reducing to six months by the end of 2004).

Q. Who will be most affected by these changes?

Applicants intending to be in New Zealand for more than 12 months will be affected, as they will all be required to undergo health and disability screening (presently applies to applicants intending to be in New Zealand for two years or more). The TB screening changes will affect temporary applicants from high incidence countries and/or who have risk factors, and who intend to be in New Zealand for six months or more.

Q. What are the high-risk countries for TB?

High-risk countries are defined as those countries with a rate of over approximately 20 cases of TB per 100,000 population (plus countries where the notification rate is likely to be inaccurately low due to poor diagnosis and notification).

Comprehensive lists of high and low incidence countries are attached in Appendix 1.

Q. What are the risk factors for TB screening?

Having accumulated three months or more in the last five years in a country, or countries, which have a high incidence of TB.

Q. What about those travellers from visa free countries who might have TB or some other illness? How will this be picked up?

The maximum duration of a permit granted to visitors from visa free countries is three months (other than the United Kingdom, which is six months). Therefore, visitors from high-risk countries wishing to extend their stay beyond the six month period, will be required to be TB screened onshore. Once their intended stay extends beyond a year, all applicants will have to undertake the full health and disability screening examination before a further permit will be granted.

Q. What does it mean for those travellers from one of the high-risk countries who are already in New Zealand but haven't been screened? What should they do/where should they go to?

For those travellers already in New Zealand, changes to health policies will only apply if they apply for a further permit. Travellers can call the New Zealand Immigration Service (NZIS) Contact Centre on 0508 55 88 55 for advice on their specific circumstances.

Q. Do the changes affect existing permanent residents?

No.

Q. Do the changes affect people who are in New Zealand on a work or student or visitor's permit?

Once the changes have been implemented, they may apply to people intending to extend their stay beyond the duration of their current permit.

Q. What other health screening initiatives are being introduced this year?

The NZIS is working closely with the Ministry of Health to conduct ongoing reviews of the health and disability screening policy. Additional enhancements to New Zealand's health and disability screening policy scheduled for 2004 include a range of tests which are known indicators of ill health and disability. These tests include: screening for HIV/Aids; standard development tests; mobility and levels of dependency.

Q. Why are these enhancements being introduced throughout 2004? Why not introduce them all now?

Introducing more robust screening measures for migrants and refugees requires new processes and enhanced support mechanisms, including additional resources. By staggering the introduction of these health and disability screening initiatives, we are able to ensure that the adequate level of resourcing and support exists for these initiatives so that health providers and customers are adequately informed on the detail of the changes at the time the changes take effect.

The NZIS is working closely with the Ministry of Health to ensure that the tests used are the most up-to-date available.

Appendix 1

As at 19 January 2003, the NZIS considers the following countries to be high incidence countries for the purpose of enhanced immigration TB screening:

Antigua; Afghanistan; Albania; Algeria; Andorra; Angola; Argentina; Armenia; Azerbaijan; Bahamas, The; Bahrain; Bangladesh; Barbados; Belarus; Belize; Benin; Bhutan; Bolivia; Bosnia and Herzegovina; Botswana; Brazil; Brunei; Bulgaria; Burkina Faso; Burma; Burundi; Cambodia; Cameroon; Cape Verde; Central African Republic; Chad; China; Colombia; Comoros; Congo(Brazzaville); Congo (Kinshasa); Costa Rica; Cote D'Ivoire; Croatia; Cuba; Djibouti; Dominica; Dominican Republic; East Timor; Ecuador; Egypt; El Salvador; Equatorial Guinea; Eritrea; Estonia; Ethiopia; Fiji; Gabon; Gambia, The; Georgia; Ghana; Greece; Grenada; Guatemala; Guinea; Guinea-Bissau; Guyana; Haiti; Honduras; Hungary; India; Indonesia; Iran; Iraq; Israel; Jamaica; Japan; Jordan; Kazakhstan; Kenya; Kiribati; Korea, North; Korea, South; Kuwait; Kyrgyzstan; Laos; Latvia; Lebanon; Lesotho; Liberia; Libya; Lithuania; Macedonia, The former Yugoslav Republic; Madagascar; Malawi; Malaysia; Maldives; Mali; Marshall Islands; Mauritania; Mauritius; Mexico; Micronesia, Federated states of; Moldova ; Mongolia; Morocco; Mozambique; Namibia; Nauru; Nepal; Nicaragua; Niger; Oman; Pakistan; Palau; Panama; Papua New Guinea; Paraguay; Peru; Philippines; Poland; Portugal; Puerto Rico; Qatar; Romania; Russia; Rwanda; Saint Kitts and Nevis; Saint Lucia; Saint Vincent and the Grenadines; Samoa; San Marino; Sao Tome and Principe; Saudi Arabia; Senegal; Serbia and Montenegro; Seychelles; Sierra Leone; Singapore; Slovakia; Slovenia; Solomon Islands; Somalia; South Africa; Spain; Sri Lanka; Sudan; Surinam; Swaziland; Syria; Tajikistan; Tanzania; Thailand; Togo; Tonga; Trinidad and Tobago; Tunisia; Turkey; Turkmenistan; Tuvalu; Uganda; Ukraine; United Arab Emirates; Uruguay; Uzbekistan; Vanuatu; Venezuela; Vietnam; Yemen; Zambia; Zimbabwe.

If you are from one of these countries or have accumulated three or more months in one or more of these countries, and you are applying to enter or stay in New Zealand for more than six months, you will be required to submit a chest x-ray.

As at 19 January 2003, the NZIS considers the following countries to be low incidence countries for the purpose of enhanced immigration TB screening: Australia, Austria, Belgium, Canada, Chile, Cyprus, Czech Republic, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Liechtenstein, Luxembourg, Malta, Monaco, Netherlands, Norway, Sweden, Switzerland, United Kingdom, United States of America and Vatican City.

ENDS


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