Province determines more than 40 medical clinics advertising membership fees

Alberta's health ministry has determined that more than 40 medical clinics in the province are advertising membership fees for services, nearly a year after one such plan landed a Calgary clinic in hot water.

An audit was launched last December. In July, CBC News reported that a medical clinic in Calgary's Marda Loop district 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 equated to patients purchasing "preferential access" and warned Alberta that it could face cuts to federal health transfers if the situation wasn't handled. 

Alberta Premier Danielle Smith and Alberta Health Minister Adriana LaGrange directed Alberta Health to investigate, and the clinic halted its plan for membership fees shortly after. 

In December, LaGrange told CBC News that "appropriate action" would be taken if audits determined that violations were found, adding the province would do whatever it took to ensure clinics were in compliance.

The province promised the audits early in the new year. Now, the health ministry says it has conducted interviews to gather information on operations and business models of the clinics, adding this work is ongoing.

"Over 40 clinics in the province [advertise] a membership 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," wrote spokesperson Andrea Smith in a statement.

"Once this review is completed, its findings will be used to inform next steps. Alberta's government will also determine if additional audits of more membership clinics is required."

In July, Health Canada said executive and primary health clinics charging patients enrolment and annual membership fees exist in a number of provinces. Generally, investigations have indicated that clinics provide members with an variety of uninsured services, such as life coaching and nutritional services.

"However, in some cases … these fees are also a prerequisite to accessing insured services at the clinic (i.e., medically necessary physician services). Mandatory fees to access or receive preferential access to insured services are contrary to the Canada Health Act," the government department wrote in a statement.

A spokesperson for LaGrange told CBC News in July the ministry wasn't aware of any other clinics offering services for membership fees that didn't align with legislation.

What comes next for those 40 clinics is a murky grey area, said Fiona Clement, a professor at the University of Calgary in the department of community health sciences. Much of it has to do with the exact language being used when services are outlined as parts of packages.

"We're on the razor's edge of exact wording there that runs them afoul. Really, I think it will come down to what the government is willing to fight with these clinics about," she said.

CBC News asked the provincial government for a list of the clinics identified, but did not receive it by publication time. A spokesperson with the province said if any clinics are found to be non-compliant with legislation, appropriate action would be taken.

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 are charging access to medical care, which is the part that contravenes the Canada Health Act," Clement said.

At the time the Marda Loop clinic fell under scrutiny, it was clear there were other such clinics 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 payment across the country. Between November 2019 and June 2020, the period of the analysis, there were 14 private clinics in Alberta with a range of membership fees and private payment.

"So, 40 is a larger number than I was expecting. And I think it speaks to growth in this area, the number of clinics that are charging fees for different parts of care," Clement said.

"I think it underscores the lack of stability, and the need to really think about how we're funding primary care, because more and more clinics are turning to this private charge as a revenue source to keep the doors open."

Provinces that allow private health-care providers to charge patients for medically necessary services have 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 reimbursements tied to its March 2023 and 2024 deductions, which represents actions that 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's still a big number, which says there's still a lot of patient billing going on," she said.