In 2023, Alberta audited publicly-subsidized medical clinics charging their patients a membership fee to assess their compliance. The review encompassed 13 clinics across the province, aiming to assess how these fees affect patient care and compliance with healthcare regulations. These results provide evidence that patients paying for membership are likely to receive more comprehensive care. This begs the question of what this means for Alberta’s publicly funded health care system.
As this audit revealed, physicians at the audited clinics almost always saw fewer patients. Their peers in more traditional practices were much more booked. This smaller patient load gives my doctors the ability to spend longer, more in-depth appointments with each patient. As the report points out, members of these clinics are provided more service units per visit. This indicates that their appointments are deeper and more wide-ranging than for non-members.
And countless patients are lured by the siren song of improved amenities and offerings. Yet, what the audit uncovered is that few patients end up paying out of pocket for billed covered medical treatments. Many public health advocates and experts are wary of the long-term consequences that could be brought about by these membership models. As Dr. Luanne Metz reminds us, we face a hurdle. She explained, “It’s really difficult to reconcile that if you can only be a member in order to receive those services.
The audit found one Calgary area medical clinic’s plan, offering families the option of paying annual fees of upwards of $5,000. Each individual adult would be penalized at a cost of about $2,000. This should be a wake-up call about access to essential medical services for anyone who can’t afford or won’t pay these fees. One surprising finding from the report was that three of the clinics only planned to provide virtual services. In comparison, four clinics provided care only to their members, serving insured and uninsured patients.
The audit discovered zero actual evidence that physicians were engaging in cherry-picking, or that they were putting members before non-members. In fact, it stressed this point throughout its recommendations. This element does not address the concerns raised about the potential impact of membership-based models in an otherwise publicly funded health system. Lorian Hardcastle, a health policy expert, commented on the need for monitoring: “This report shows you that there are things going on that need, at the minimum, monitoring. Honestly we only need to make it right so folks are accessing the public health care that they deserve.”
If the Canada Health Act is violated, Health Canada has a duty to enforce compliance. This law makes it illegal to charge patients for services that are medically necessary. Operationally, the audit showed clinics are understanding of the difference between insured and uninsured services. It recognized that overlap is sometimes unavoidable, underscoring the need to prevent duplicate billing specifically. A recent settlement case emphasizes that although clinics might do well to aim for compliance, uncertainties still remain on the ground.
Despite these findings, officials from the office of Primary and Preventative Health Services Minister Adriana LaGrange expressed satisfaction with the audit results. They particularly welcomed the findings of the audit. It found no material non-compliance and ensured that nobody is being billed for services covered by the insurance. Opponents say those promises ring hollow, as critics point out they fail to answer larger systemic issues when it comes to access to care.
The establishment of more than 40 private, for-profit medical clinics in Alberta that require payment of membership fees has attracted both local and national political leaders’ ire. The New Democratic Party (NDP) has been calling for a public inquiry. They are hoping to find out just how widespread these extra fees are in Alberta’s healthcare system. We believe this call for increased scrutiny is a natural response to the increasing calls for equity and access to important healthcare services.
