This year, Alberta announced a province-wide audit to glean the state of the practice from medical clinics charging a fee for a faster or better service. Our review includes all 13 clinics in the province. Further, it has sparked national conversations about the deleterious effects of these fees on patient care and adherence to the Canada Health Act.
The audit revealed that physicians working in these membership-based clinics tended to see significantly fewer patients compared to their counterparts in traditional practices. This lower patient panel seems to free up these doc’s schedules for 60-90 min long, much more robust appointments with their members. To ensure members who are paying fees receive better quality care as well. It raises fears about equitable access to healthcare among all of America’s citizens.
Reportedly, members of these clinics have received more complete care than non-members. Additionally, the audit found no widespread cases of patients being charged out-of-pocket. Treatments that are federally mandated, medically necessary and covered by provincial health insurance were not listed. This is an exceptionally important finding. It is an empirical demonstration that, even when the financial model departs from a single-payer system, the core principles of the Canada Health Act can be maintained.
Among the notable examples, a Calgary-based medical clinic planned to charge annual fees of approximately $5,000 for families and $2,000 for individual adults. More than 40 clinics throughout Alberta are actively promoting comparable subscription fees. This upsurge is a sign of a larger wave that’s rolling through the healthcare delivery model.
The Canada Health Act only has one hard and fast rule. If provinces allow providers to bill for services that should be free, provinces lose their federal health transfer payments. The audit ultimately uncovered no evidence that physicians were pressured to favor members over non-members. What it did uncover is an interesting potential gap between services delivered to the insured versus uninsured, right on the same visit.
Three of the reviewed clinics primarily offered virtual services, while four provided both insured and uninsured services exclusively to members. This patchwork of service offerings further muddles the compliance landscape, leading many advocates to call for improved and more defined regulations within this growing sector.
The report states, “Although clinics generally understand the distinction between insured and uninsured services and the importance of avoiding extra-billing, some overlap is difficult to rule out, as uninsured allied health services may be delivered during visits that include insured services.”
Minister of Primary and Preventative Health Services Adriana LaGrange’s office commented on the findings, stating, “Membership clinics operate as private businesses within Alberta’s publicly funded health system, with physicians working as independent contractors under approved compensation models.” They derided the audit’s overall finding of no material non-compliance as a victory.
“We’re pleased the audit found no significant non-compliance and no evidence that anyone is being charged for insured services.” – Office of Primary and Preventative Health Services Minister Adriana LaGrange
These compliance positive results—overall and for specific elevating platforms—are heartening. Opponents point out that membership charge fosters inequities in care. Lorian Hardcastle, a law professor specializing in health policy, remarked, “This report shows you that there are things going on that need, at the minimum, monitoring. Ideally we just need to fix it so people get the public health care that they need.”
Dr. Luanne Metz similarly expressed her concern over what providing exclusive member-only access would mean. She noted, “It’s pretty hard to reconcile that if you only can be a member to get those services.” This concern echoes a larger fear that these models will create unequal access to high-quality and necessary healthcare.
We are pleased that Health Canada is moving towards legislating the long-term compliance with the current law. A spokesperson stated, “Health Canada is reviewing the recently released report and will continue engaging with the province to ensure that patients do not face patient charges to access medically necessary services.”
Launching membership clinics is becoming an Alberta trend. In turn, the New Democratic Party (NDP) is calling for a deeper investigation into the number of medical clinics that are charging ‘member’ fees.
