Health Canada says a Calgary medical clinic that soon plans to charge its patients a fee to gain faster access to a family doctor would be breaching medicare laws.
The federal agency says Alberta risks losing federal transfer health payments if it doesn’t do something about it, but Premier Danielle Smith says if rules are being broken they will act.
“Canadians should have access to primary health-care services based on medical need and not on their ability, or willingness, to pay,” Health Canada said in a statement Tuesday.
“The Government of Canada does not support a two-tiered health-care system where patients may choose, or be required, to pay membership fees to access insured primary care services at clinics, or to gain expedited access to those services.”
The issue surrounds the Marda Loop Medical Clinic, which has told its patients that starting next week, it will still see patients for free one day a week. The other four days will be dedicated to patients who pay annual membership fees such as $2,200 for an individual and $4,800 for a family.
For that money, the clinic promises faster access to the clinic physician, along with other perks and services, including extended sessions, at-home blood tests and discounts on related services such as physiotherapy.
Health Canada said it has written to Alberta officials to inform them that "the ability for patients to purchase preferential access is contrary to the Canada Health Act," the statement said.
“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.”
Health Canada said provinces have several options when medicare laws are breached, including amending legislation or making program and other policy changes. However, it said that unless the problem is fixed, "a mandatory deduction to federal health transfer payments to the province or territory must be taken.”
Later Tuesday, Smith and Health Minister Adriana LaGrange issued a statement saying they are investigating the Marda Loop program.
"Alberta’s government would be extremely concerned if this clinic were charging fees for services that are insured and offering accelerated access to a family physician, at the expense of other patients needing to wait longer," said Smith and LaGrange.
"We have directed Alberta Health to investigate this specific clinic to ensure compliance with all legislation. If any non-compliance with relevant legislation is found, we will take appropriate action.
"Albertans do not pay out of pocket for insured health services such as seeing a family doctor or visiting a hospital – that will not change.”
Dr. Sally Talbot-Jones, the owner and physician at Marda Loop Medical Clinic, has not responded to requests for comment.
Friends of Medicare, an Alberta-based advocacy organization, and Alberta’s Opposition NDP have said the province needs to put a stop to the fee plan.
"Using a loophole to charge a membership fee to restrict that access or to give priority access … is unfair. It goes against the Canada Health Act and the spirit of what our public health-care system is supposed to be," said Chris Gallaway, executive director of Friends of Medicare.
"If this is allowed and they go ahead with it, other clinics will look at doing the same thing. That undermines our public health-care system, and it undermines access to primary care."
NDP health critic David Shepherd said given that the family doctor is the gateway to referrals for more specialized testing and treatment, a further bottleneck there would have an exponential effect on the rest of the system.
Fiona Clement, a professor who specializes in health policy at the University of Calgary, said there aren't a lot of family doctors taking new patients, so it would be difficult for a patient to find a doctor if they can't afford to pay or choose not to pay the membership fee.
"Primary care is the cornerstone of our health-care system and of health for many people," said Clement.
"If you lose your primary care doctor and can't find a new one, you don't have very many options when you're ill. You need care, so you're either doing walk-in clinics, urgent care clinics, the emergency room. It's not great."
Smith has faced concerns over comments she made before she became premier last fall, such as advocating in multiple interviews and in an academic policy paper that Albertans should pay out of pocket for some medically necessary services — such as seeing a family doctor — to ensure the system can remain sustainable over the long term.
Smith, however, has since promised her United Conservative Party government is committed to medicare.
Her mandate letter to LaGrange last week urged the minister to improve the system "within the pillars of the Canada Health Act and, importantly, in alignment with our government's Public Health Care Guarantee that no Albertan will ever have to pay out of pocket to see their doctor or receive a needed medical treatment."
This report by The Canadian Press was first published July 25, 2023.
Dean Bennett and Colette Derworiz, The Canadian Press
Note to readers: This is a corrected story. A previous version said Chris Gallaway is the president of Friends of Medicare.
