Province directs Alberta Health to investigate Calgary clinic charging membership fees

Health Canada says it has written to Alberta officials to inform them that the ability for patients "to purchase preferential access" at a Calgary clinicrunscontrary to the Canada Health Act.

"We are working collaboratively with the province of Alberta to ensure the clinic's patients continue to receive medically necessary services free of patient charges," the government department wrote in an email.

On Monday, CBC News reported that a Calgary clinic had told its members that it would be moving to a membership model.

The pricing under that model, shared with CBC News, was listed as $4,800 per year for a two-parent family membership, covering two adults and their dependent children.

Other memberships included a $2,400-per-year membership that covers one adult and their dependent children, and $2,200 per year for an individual adult membership.

In the statement, Health Canada wrote that Canadians should have access to primary health care services based on medical need, and not on their ability or willingness to pay.

"The Government of Canadadoes not support a two-tiered health care system where patients may choose, or be required, to pay membership fees to access insured primary care services at clinics, or to gain expedited access to those services," the statement reads.

Membership fees at private clinics are considered patient charges under the Canada Health Act and raise concerns under the accessibility requirement of the act, officials said.

"We are working collaboratively with the province of Alberta to ensure the clinic's patients continue to receive medically necessary services free of patient charges," the statement reads.

In a joint statement issued later Tuesday, Premier Danielle Smith and Alberta Health MinisterAdriana LaGrange said they'vedirected Alberta Health to investigate theclinic to ensure compliance with all legislation.

They said if any non-compliance with relevant legislation is found, appropriate action will be taken.

"Alberta's government would be extremely concerned if this clinic were charging fees for services that are insured and offering accelerated access to a family physician, at the expense of other patients needing to wait longer," theysaid.

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Other clinics across Canada

The Marda Loop clinic is not the only such clinic providing membership programs, in Calgary or in Canada.

Researchers from Dalhousie University and Simon Fraser Universityreleased a paperin 2022 which trackedthe number of clinics taking private payment across the country.

At the time of the analysis between November 2019 and June 2020 there were 14 private clinics in Alberta with a range of membership fees and private payment.During that same period, there were 24 in Ontario and 30 in Quebec.

A spokesperson in the federal health ministry saidother clinics in Calgary and Alberta charging membership feescould also expect such a response in the future.

Under theCanada Health Act,patients can't be charged for "medically necessary" services that areprovided in a hospital or by a doctor. If that happens, provinces that allow private health-care providers to do so will havedollarsclawed backby the federal government.

"It is not allowable that you would charge a patient as they come in to see a doctor for the care that you provide them,"Fiona Clement, a professor who specializes in health policy in the department of community health sciences at the University of Calgary, previously told CBC News.

"But what is being tried, and I think kind of skirting the bounds of what's allowable,are these membership fees."

Health Canada said in its statement that where there is evidence of patient charges, mandatory deductions to federal health transfer payments to the province or territory must be taken.

Prior to the Health Canada release on Tuesday, Alberta NDP Leader Rachel Notley said the decision made by the Marda Loop clinic "undermines the very values of public healthcare."

"Public healthcare means every Albertan gets the care they need, when they need it and where they need it, regardless of the amount of money in their pocket," Notley wrote.

Calgary clinic owner cites struggle to pay overhead

Reached at her clinicTuesday, Dr. Sally Talbot-Jones, owner and manager of the Marda Loop Medical Clinic, said it had taken her a year to reach the decision she did, citing struggles to meet overhead.

"We're empathetic people. We want to look after patients. But at the end of the day, the bank doesn't care that you're empathetic," she said. "And patients were actually asking for options."

Talbot-Jones said such an arrangement enabled her to be able to look after people who were looking to secure access to extra appointments.

In response to the statement from Health Canada, Talbot-Jones noted that there are many private clinics in Calgary many of which may not be advertising.

"This is not the first time it's happened. I'm just, kind of, made this public at the wrong time, when people are upset," she said.

Talbot-Jones said her clinic shouldn't be considered in contravention of the Canada Health Act, because a membership clinic offers more than just health-care to its clients.

"I am just helping those people that need the extra time," she said.

Dr. Alika Lafontaine, president of theCanadian Medical Association,said that providing different levels of access to health services based on ability to pay can negatively impact patients who are in greatest need of care.

"We must also remember however that pay-out-of-pocket approaches become more prevalent as our public health systems deteriorate as we have seen nationwide," Lafontaine wrote in a statement.

"Lack of investment, outdated incentives, and unhealthy working environments must be improved if we're to have providers remain committed [to] our public health systems and to ensure that delivery provides adequate access to needed health services."

The College of Family Physicians of Canada responded to the clinic's move on social media.

"Charging patients for access goes against the principles of Canada Health Act, but is symptomatic of the pressures amid the crisis facing family doctors. Sustained investment into family medicine is crucial to ensuring accessible care for patients," the college wrote.