Alberta Health Minister Adriana LaGrange, speaking at Peter Lougheed Hospital in August. She has directed her department to further investigate clinics that have a membership component to their services. (Jeff McIntosh/The Canadian Press)
The government of Alberta is gearing up for an audit plan to investigate potential breaches of health policies by medical clinics charging membership fees for services. The backdrop to this initiative is the guarantee of medically necessary care under the Canada Health Act, where provincial health insurance covers hospital visits and doctor appointments. However, private medical clinics have the leeway to charge for uninsured services.
Concerns have arisen due to pitches from certain clinics urging patients to pay membership fees for enhanced services or care. Questions about compliance with national legislation have been raised by members of the public and health experts, prompting Health Minister Adriana LaGrange to initiate a closer examination.
LaGrange's office released a statement to CBC News, saying, "Out of an abundance of caution, the minister has directed her department to further investigate clinics that have a membership component to their services." The department is currently reviewing a sample of eight clinics in Alberta, and the results will inform the development of a comprehensive audit plan.
Additional audits are planned for early next year, and if violations are uncovered, "appropriate action" will be taken. Minister LaGrange emphasized the seriousness of the matter, stating, "We will do whatever it takes to ensure that they're in compliance. We take this very seriously."
LaGrange expressed openness to restricting provincial funding for clinics not operating in good faith, underlining the necessity of adhering to the Canada Health Act and the Alberta Health Insurance Act.
The health department is already vigilant in monitoring billing activities to ensure clinics comply with legislation. The minister's office reiterated that Albertans would not be required to pay out of pocket for hospital or family doctor visits.
The investigation into a medical clinic in Calgary's Marda Loop neighborhood earlier this year brought attention to uncertainties surrounding access to healthcare. The clinic's move towards a subscription system and plans to charge substantial membership fees prompted an Alberta Health inquiry after it was deemed contrary to the Canada Health Act. Another clinic, JW Health in Calgary, is now facing similar scrutiny after it was found to be offering services under a membership model.
JW Health's services, priced at about $3,000 per year, include extended hours, no charges for doctor's notes, prescription refills without appointments, and preventative screening. The clinic clarified that membership fees only apply to uninsured components of care, and membership is not a prerequisite to access a doctor.
In response to inquiries, JW Health stated that its membership model was developed after legal advice and consultations with Alberta's College of Physicians and Surgeons. It affirmed its readiness to comply with any changes ordered by the health department.
Public health expert Fiona Clement from the University of Calgary commended the government's commitment to aligning with the Canada Health Act. She acknowledged the murkiness surrounding differences in care but emphasized the importance of scrutinizing these clinics to ensure compliance.
The Canada Health Act stipulates that provinces allowing private healthcare providers to charge for medically necessary services risk reductions in federal transfers. A recent example is Harrison Healthcare's practices related to diagnostic imaging, leading to a $13 million deduction in federal health transfers to Alberta by Ottawa earlier this year.
