Achi news desk-
Alberta’s health ministry says an audit has determined more than 40 medical clinics in the province are advertising membership fees for services, nearly a year after one such scheme landed a Calgary clinic in hot water.
The audit was launched last December. In July, CBC News reported that a medical clinic in Calgary’s Marda Loop area was moving to a membership system and planned to charge $4,800 a year for a two-parent family membership, covering two adults and their dependent children.
The next day, Health Canada said the arrangement at the Marda Loop Medical Clinic amounts to patients buying “preferential access” and warned Alberta it could face cuts to federal health transfers if the situation is not addressed.
Alberta Premier Danielle Smith and Alberta Health Minister Adriana LaGrange directed Alberta Health to investigate, and the clinic suspended its plan for membership fees shortly thereafter.
In December, LaGrange told CBC News that “appropriate action” would be taken if inspections determined violations were found, adding that the province would do whatever it took to ensure clinics complies.
The province promised the inspections early in the new year. Now, the health ministry says it has conducted interviews to gather information about the clinics’ operations and business models, adding that this work continues.
“Over 40 clinics in the province [advertise] membership was meant to pay for a defined set of uninsured services, while also providing insured services covered under the Alberta Health Care Insurance Plan at no cost to Albertans,” spokeswoman Andrea Smith wrote in a statement.
“Once this review has been completed, its findings will be used to inform the next steps. The Alberta government will also determine whether additional inspections of more membership clinics are needed.”
In July, Health Canada said active and primary health clinics that charge patient registration fees and annual membership fees exist in a number of provinces. In general, investigations have indicated that clinics provide a variety of uninsured services to members, such as life coaching and nutrition services.
“However, in some cases … these fees are also a prerequisite to accessing insured services at the clinic (ie, medically necessary physician services). Mandatory fees to access or receive preferential access to insured services are a violation of the Canada Health Act,” the government department wrote in a statement.
A spokesperson for LaGrange told CBC News in July that the ministry was not aware of any other clinics offering services for membership fees that were not in line with legislation.
What comes next for those 40 clinics is a dark gray area, said Fiona Clement, a University of Calgary professor in the department of community health sciences. Much of it has to do with the exact language used when services are outlined as part of packages.
“We’re on the razor’s edge of exact wording there that makes them miserable. Frankly, I think it will depend on what the government is willing to fight these clinics about,” he said.
CBC News asked the provincial government for a list of the identified clinics, but did not receive it by press time. A spokesperson for the province said that if any clinics are found to be non-compliant with legislation, appropriate action will be taken.
The report had identified 14 clinics
Clement said the big issue that got the Marda Loop Medical Clinic in hot water was the concept of guaranteed access.
“That’s the problem that Marda Loop got into, because there you’re charging for access to medical care, which is the part that goes against the Canada Health Act,” Clement said.
At the time the Marda Loop clinic was under scrutiny, it was clear that other such clinics were providing membership programs, in Calgary and Canada.
In 2022, researchers from Dalhousie University and Simon Fraser University released a paper tracking the number of clinics taking private payments across the country. Between November 2019 and June 2020, the period of analysis, there were 14 private clinics in Alberta with a range of membership fees and private payment.
“So, 40 is a bigger number than I expected. And I think it speaks to growth in this area, the number of clinics charging fees for different parts of care,” Clement said.
“I think it underlines the lack of stability, and the need to think seriously about how we fund primary care, because more and more clinics are turning to this private charge as a source of revenue to keep” r doors open.”
Provinces that allow private health care providers to charge patients for medically necessary services have had dollars clawed back by the federal government under the Canada Health Act.
According to Health Canada, Alberta was subject to a $20,450,175 deduction to its Canada Health Transfer payment in March 2024 under the diagnostic services policy. That’s up from $13,781,152 last year.
But the province received $20,538,796 in partial refunds related to its March 2023 and 2024 deductions, which represent steps Alberta Health has taken to limit patient pay for publicly funded goods or services, according to Clement.
“I guess we’re making some progress. But it is still a large number, which says that many patient bills are still going on,” he said.
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