Health Canada opposes 'preferential access' at private clinics, says it contravenes Canada Health Act

According to a 2022 research paper, Alberta had 14 private clinics between November 2019 and June 2020 with membership models and annual fees. During that same period, 24 private clinics existed in Ontario and another 30 in Québec.

  • Rebel News
  • July 26, 2023
  • News
Health Canada opposes 'preferential access' at private clinics, says it contravenes Canada Health Act
Facebook / Danielle Smith and Facebook/ Marda Loop Medical Clinic
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A Calgary clinic is charging members thousands of dollars annually as part of its "preferential access" membership model — a move that Health Canada claims is in contravention of the Canada Health Act. 

Dr. Sally Talbot-Jones, owner and manager of the Marda Loop Medical Clinic, said her struggles to meet overhead costs forced her to adopt a membership model.

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

Talbot-Jones said her patients came to her for healthcare alternatives, adding that her model enabled patients to secure access to extra appointments.

Membership for two-parent households and their dependent children cost $4,800 annually, whereas one-parent families pay $2,400. For a single adult, it's $2,200 a year.

On Monday, Health Canada said Canadians should have access to primary healthcare services based on medical needs, rather than their ability or willingness to pay.

"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," said a spokesperson for the federal agency.

Officials contend that membership fees at private clinics are patient charges under the Act, and raise accessibility concerns.

A statement affirmed their opposition Tuesday to a "two-tiered healthcare system" where patients can gain expedited access to primary care services.

However, Talbot-Jones said her clinic offers more than just healthcare and should not be considered in contravention of the Canada Health Act.

"I am just helping those [who] need the extra time," she said.

In a joint statement issued later Tuesday, Premier Danielle Smith and Alberta Health Minister Adriana LaGrange directed Alberta Health Services to investigate the clinic to ensure compliance with all legislation, including the Alberta Health Care Insurance Act (AHCIA).

Should they find that Maria Loop Medical Clinic contravenes the Canada Health Act, Smith and LaGrange said they would take the necessary action.

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

However, Marda Loop is one of many clinics providing similar membership programs in Calgary or Canada. 

According to a 2022 research paper, Alberta had 14 private clinics between November 2019 and June 2020 with membership models and annual fees. During that same period, 24 private clinics existed in Ontario and another 30 in Québec.

The Health Canada spokesperson said the other Alberta clinics should expect a similar response momentarily.

"We are aware that there are physicians and clinics in Alberta that have operated for decades within the parameters of the law to provide services not covered by the provincial health care insurance plan," said the joint statement from the Alberta government.

According to the province, these services include non-medically required surgeries, nutrition and acupuncture services, medical notes and fertility treatments.

Under the Canada Health Act, provinces that allow private healthcare providers to charge for "medically necessary" services would be allocated fewer federal dollars to spend on healthcare.

"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," said Fiona Clement, a professor of community health sciences at the University of Calgary.

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

According to the Alberta government, the Audit and Compliance Assurance Unit of Alberta Health has "evaluated instances where private clinics operate this way."

"Alberta Health submits an annual report to Health Canada and has yet to identify an issue with the operation of these clinics," reads the joint statement.

While the College of Family Physicians of Canada condemned "charging patients for access," they acknowledged that membership models are "symptomatic of the pressures amid the crisis facing family doctors." 

"Sustained investment into family medicine is crucial to ensuring accessible patient care," the college wrote.

The UCP reaffirmed their campaign pledge Tuesday not to make Albertans pay out of pocket for insured health services, including seeing a family doctor or visiting a hospital.

Health policy experts have long opposed private alternatives in Canada over concerns that a two-tier system encourages "queue-jumping" and favours wealthy patients. However, a controversial 2005 Supreme Court ruling in the case of Chaoulli v Quebec found that "access to a waiting list is not access to health care." This ruling no longer permits Québec to 'ration' health care for its citizens while blocking them from paying for private alternatives.

But on April 6, 2023, the Supreme Court refused to hear an appeal from a Vancouver-based surgeon, Dr. Brian Day, who contends that the restriction of access to private healthcare ultimately harms middle-class and lower-income Canadians.

"Wealthy Canadians have always gone down to the United States [for care], but where do middle-income and lower-income Canadians go?" Day wrote in his argument to the court. 

According to SecondStreet.org, government data showed at least 41,620 Canadians have died while waiting for surgery and diagnostic scans since 2018/19. 

"[Middle-class and lower-income Canadians] suffer and die on wait lists," said Day, adding that nearly three-quarters of Canadians want private insurance to access alternative care options.

Colin Craig, president of SecondStreet.org, concurred that the court decision is "disappointing." 

"How can the Supreme Court conclude in 2005 that Québecers can pay for private surgery but decide today that the rest of the country cannot?" he said.

Each year, SecondStreet.org files freedom of information requests nationwide with health regions and provincial health bodies to gather data on the number of patients removed from waiting lists for surgery, diagnostic scans and appointments with specialists due to death. 

Released in December 2022, SecondStreet.org's 2021-22 Died on a Waiting List report showed 13,581 'waiting list deaths' spanning various health services — cardiac surgery, cataract surgery, hip operations, MRI scans, etc. 

Updated data from March brings the total number of waiting list deaths last year to 14,057, including 48 Albertans who died waiting for surgery and 79 who died waiting for a diagnostic scan. 

For the remainder of the 2021/22 fiscal year, it is unknown how many Albertans died waiting for life-saving surgeries or procedures, as the province did not track that data.

Residents waited as much as 1,229 days for life-saving surgeries and 695 days for a diagnostic scan during that period.

The policy think tank recommended that provinces permit patients to pay for surgeries and other procedures at private clinics while keeping the public health care system public, to curb lengthening wait lists.

"Countries with better performing universal health care systems allow this choice," added Craig.

"[Before] COVID, many surgeons would tell you they had lots of free time. This was [because] the government hadn't allocated enough funding for them to provide more surgeries," read a SecondStreet.org release.

"People refer to [this] as 'rationed health care.'"

In 2019, Red Deer resident Bradley McEwen waited months for hip replacement surgery. Every day, he experienced unbearable pain and reduced mobility. He could neither work nor get around his household. 

"[It] was to the point where I couldn't get up the stairs. I couldn't walk. I couldn't sit. I couldn't lay. I couldn't do anything. I was done, I was finished," McEwen told CBC.

After a family member offered to pay roughly $20,000 for his hip replacement, McEwen had his surgery at a private clinic in Laval, Québec.

"I walked away — no pain. As soon as they do the surgery, the pain stops," said the Red Deer resident.

"The Supreme Court's decision not only leaves Québecers with more health care rights than everyone else in Canada, but provincial governments will continue to be allowed to ration health care in this country while blocking patients from accessing private health care," said SecondStreet.org.

"No other developed nation on earth does this."

Canada news Alberta Calgary Health & Medical
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