Alberta patients paying clinic membership fees get better care, audit suggests

CBC

2 days ago

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An audit of Alberta medical clinics charging membership fees found no significant cases of patients paying out of pocket for covered medical treatment, but paying members are likely getting more thorough care.
The province launched the audit in 2023, in response to concerns over a Calgary medical clinic switching to a membership model and planning to charge annual fees of about $5,000 for families and $2,000 for an adult.
Ads promised patients shorter wait-times and extended appointments, but experts warned membership fees would create a two-tiered health system benefiting those who can pay.
Health Canada, at the time, said a membership system was contrary to a federal law protecting people from paying for medically necessary care, as it meant Albertans were paying for preferential access to doctors.
A two-page summary of the audit, which reviewed 13 clinics, says physicians in the clinics saw substantially fewer patients than other doctors and members seemed to get longer and more comprehensive appointments than non-members.
"Membership clinics averaged 232 new patients per physician, compared to an average of 965 in public clinics," the report says.
"Members of these clinics receive more service units per visit, suggesting longer or more comprehensive appointments than those provided to non-members."
The report, published earlier this week, says there was "no evidence that physicians were incentivized to prioritize members over non-members."
There was also no evidence to suggest the clinics were intentionally breaking the law by charging patients for what should be free medical care, it says. Although four of the clinics provided insured and uninsured services only to members.
Uninsured services aren't covered under public health plans and include doctor's notes and forms and certain cosmetic procedures.
The report doesn't say how much the clinics charged for memberships or where they're located. It says three provide primarily virtual services, "one of which requires payment to access an online platform where both insured and uninsured services are delivered."
The report makes policy recommendations for the province to ensure clinics are more regulated and to address grey areas where patients get insured and uninsured services during the same appointment.
"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 also include insured services," the report says.
The office of Primary and Preventative Health Services Minister Adriana LaGrange says in a statement that the province is reviewing the recommendations and legislative changes are possible.
"Membership clinics operate as private businesses within Alberta's publicly funded health system, with physicians working as independent contractors under approved compensation models," the statement reads.
"We're pleased the audit found no significant non-compliance and no evidence that anyone is being charged for insured services."
LaGrange's office didn't specify what changes are being considered.
University of Calgary health law professor Lorian Hardcastle said she found the report underwhelming in detail and that it doesn't address paying for preferential access to physicians.
"Some of these clinics advertise not just that you get quicker appointments but that you can get after-hours appointments," Hardcastle said.
"You're paying for the after-hours call, but if the thing you're calling about is … just a regular medically necessary issue, then you are getting better access to care for your medically necessary issues, which I think is problematic in terms of the legislation."
"The government didn't seem, in the report, all that concerned about what they found."
Health Canada is responsible for enforcing compliance with the Canada Health Act, and Hardcastle said the agency needs to be "holding the province's feet to the fire."
The act allows Ottawa to claw back funds to provinces through health transfers, if provinces allow providers to charge patients for medically necessary or covered services.
Health Canada said in a statement that it has been in contact with Alberta about its audit and reiterated that patients paying membership fees to get preferential access to care raises concerns.
"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," the statement reads.
LISTEN | Should doctors charge membership fees?
Dr. Luanne Metz, an Opposition NDP legislature member, said the report's recommendations for clearer and enhanced regulations are important, but without more details the severity of the situation is unclear.
"This report shows you that there are things going on that need, at the minimum, monitoring. But ideally we just need to fix it so people get the public health care that they need," she said.
Metz also said the audit's findings are contradictory, as it says clinics weren't intentionally charging patients for insured care, even though it found four only provided services to members.
"It's pretty hard to reconcile that if you only can be a member to get those services," she said.