Québec has seen a record 641 private physicians in the province this year, spurring conversation on whether other provinces and territories should follow in their footsteps in pursuit of a 'fair deal.'
On August 9, Dr. Neb Kovacina, a family doctor and professor at McGill University's faculty of medicine, told CBC about more Québecers spending out of pocket to see a physician.
"Unfortunately, our population is spending more out of pocket for medical services," he said.
According to the Fall 2022 Survey for OurCare, a pan-Canadian healthcare initiative, 40% of respondents without a family doctor or nurse practitioner had to pay for medical services.
"This is double the Canadian average," added Kovacina.
"In other provinces, primary care in the private sector is either not accessible or well-controlled."
On August 1, a spokesperson to Alberta's health ministry said Marda Loop Medical Clinic, a Calgary clinic that faced pushback for tabling extensive membership fees, is no longer proceeding with the change.
Dr. Sally Talbot-Jones, owner and manager of the clinic, proposed to reduce wait times and extend appointment times for households that pay up to $4,800 annually amid concerns they could not meet overhead costs.
"We're empathetic people. We want to look after patients," she told CBC, who first reported the story. "But at the end of the day, the bank doesn't care that you're empathetic."
On July 28, Alberta Health sent a letter to the clinic voicing accessibility concerns about a membership fee model after Premier Danielle Smith and Alberta Health Minister Adriana LaGrange directed them to investigate.
Smith said her government had signed an agreement with Ottawa worth $24 billion over ten years to uphold the principles of the Canada Health Act.
"That means that you cannot charge to access insured services. If that's what [Marda Loop is] doing, they will be shut down, [...] fined, [or] we will withhold payments to them. So it won't be allowed to happen."
Talbot-Jones says her patients came to her for healthcare alternatives, adding that her model enabled patients to secure access to extra appointments.
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, 30 private clinics existed in Québec.
On Monday, Smith told Rebel News it was her understanding that Alberta had "very few" doctors who chose to operate private clinics.
On July 26, the Alberta government confirmed 13 known clinics operating in the province that offered uninsured services not included in the Canada Health Act and the healthcare insurance plan.
"My priority is to make sure that we can provide the healthcare people want and when they need it without having to pay out of pocket," she said.
"We're in the process of doing major [healthcare] reform and a major reinvestment into primary care, including recruitment — that's what I'm going to be focused on."
Health policy experts have long opposed private alternatives in Canada over concerns that a two-tier system encourages "queue-jumping" and favours wealthy patients.
According to Health Canada, Canadians should have access to primary healthcare services based on medical needs rather than their ability or willingness to pay.
A July 25 statement affirmed their opposition to a "two-tiered healthcare system" where patients can gain expedited access to primary care services.
They also deducted $13.8 million in health transfer payments from Alberta in March because clinics charged for medically necessary diagnostic services.
Under the Canada Health Act, provinces that allow private healthcare providers to charge patients for medically necessary services have dollars clawed back by the federal government.
Québec received a $41.87 million deduction at the time.
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.