In the context of Canadian immigration, "excessive demand" refers to a situation where someone looking to immigrate to Canada is deemed to impose an undue or disproportionate demand on Canada's social services and public health system.

Specifically, it applies to individuals who may require significant, ongoing, and/or expensive medical or social services that may exceed what the Canadian government considers reasonable or sustainable.

IRPA section 38:

Health grounds

(1) A foreign national is inadmissible on health grounds if their health condition

(a) is likely to be a danger to public health;

(b) is likely to be a danger to public safety; or

(c) might reasonably be expected to cause excessive demand on health or social service

In 2025, the cost threshold is $135,810 over a 5-year period (or $27,162 per year).

This assessment is made on a case-by-case basis, but IRCC uses a specific cost threshold for excessive demand. If the cost of an applicant’s medical or social services (for the applicant and their dependents) is expected to exceed this threshold over a set period demand.

This concept is most commonly applied when assessing applicants for family sponsorship (especially under the Family Class) or for permanent residence under certain economic immigration programs. For example, a Canadian citizen wishes to sponsor their new spouse who is a foreign national OR an applicant applying under an economic pathway such as the Provincial Nominee Program or Express Entry.

Exemptions and Exceptions

While every person seeking to enter Canada is subject to A38, certain temporary and permanent resident applicants are Excess Demand Exempted:

According to IRPA 38 (2) Paragraph (1) (c) does not apply in the case of a foreign national who:

Immigration Medical Exam

As part of your immigration application, you will likely need to complete an Immigration Medical Exam (IME). For temporary residence, this is only sometimes required but for permanent residence, it is always required for the principal applicant and their dependents whether accompanying or not.

A medical exam must be completed by an IRCC Panel Physician either inside Canada or outside Canada. Upon this exam (IME), the physician may detect an illness that may impose a demand on Canadian healthcare. Some examples may include diabetes, tuberculosis, cancer, heart disease, or a sexually transmitted illness.

How does IRCC establish Excessive Demand?

IRPA section A38 inadmissibility must be established on a balance of probabilities.

The landmark case with regards to medical inadmissibly can be found in reading Hilewitz v Canada (MCI) [2005] 2 SCR 706.

Para 58:

The clear legislative threshold provides that to be denied admission, the individual’s medical condition “would” or “might reasonably be expected” to result in an excessive public burden. The threshold is reasonable probability, not remote possibility. It should be more likely than not, based on a family’s circumstances, that the contingencies will materialize.

In other words, IRCC should assess the inadmissibly on a case-by-case basis and take into consideration the Applicant’s specific diagnosis, medications requirement, treatment plans, and long-term prognosis.

Implications

If an applicant is found to be inadmissible due to excessive demand, they may be denied permanent residence or be refused sponsorship under the Family Class program. However, in cases where excessive demand is the only barrier to approval, the applicant may be able to appeal or seek legal advice to explore ways to challenge the decision. The goal of this policy is to balance Canada’s humanitarian commitments with the sustainability of its healthcare and social services systems.