Best CCTV Security Camera in Brampton
Dr. Sally Talbot-Jones, owner of the Marda Loop Medical Clinic, has offered current patients enhanced health-care services for up to $4,800 per year for families. (Colin Hall/CBC)
Best CCTV Camera in Brampton
News that a Calgary medical clinic has solicited “member” fees from its patients will no doubt shock many Albertans, regardless of their ability to pay for enhanced care.
But the believers in an equitable, fully public health care system should understand this challenging reality: some Alberta clinics have been charging patients thousands for premium services since well before Premier Danielle Smith’s tenure.
The trend predates UCP predecessor Jason Kenney. And the NDP’s Rachel Notley. In fact, you can go back five premiers into the Tory dynasty, to the latter days of Ralph Klein in 2006, to find a government and health ministry reckoning with a new private health clinic offering a boutique or “concierge” service for willing residents.
And similar clinics have existed in other provinces like Ontario, Quebec and British Columbia.
But there’s something that seems to set the Marda Loop Clinic apart, that many Albertans will reasonably find unsettling.
What appears to be different or novel in this case is that Marda Loop is an existing clinic that’s switching over to premium-pay service.
Dr. Sally Talbot-Jones’ clinic in an inner-city southwest Calgary neighbourhood recently sent existing patients a letter about what it called a “transformative health care initiative.” It offered reduced wait times, longer appointments and an array of other perks, through membership that costs up to $4,800 for families.
Clinic patients who opt not to become paid members could still receive care from their doctor, but only one day a week.
The long-controversial but long-sanctioned Copeman Healthcare Centre chain of private clinics set up as new operations seeking a new list of patients. For patients at Marda Loop, the doctor and clinic they’d relied on for years transformed beneath their feet.
The switch from a public doctor’s clinic to a (mostly) private boutique seems like the health-care equivalent of a condominium conversion — in which a landlord evicts the apartment renters to renovate and sell the units as condos.
Shifting apartments to higher-cost condos pushes tenants out of their existing units and makes them seek units elsewhere. That’s a big problem when vacancy rates are low and affordability is scarce.
Marda Loop Clinic’s conversion comes during a similar scarcity crisis in health care.
Cheap CCTV Camera in Brampton
In an email sent to clients July 19, Marda Loop Medical Clinic informed its clients it would be introducing a “membership-based medical service,” running $4,800 a year for a two-parent family membership. Such arrangements have been growing increasingly common in recent years, experts say. (Mike Symington/CBC)
Home CCTV Camera in Brampton
It’s gotten harder to find a family doctor. And that will do two things in this case: leave people who cannot afford membership fees either scrounging or unable to find a family doctor; and add pressure on existing patients to pay up, rather than lose access to their physician.
This development also stands to make countless other Albertans wonder: will my doctor’s clinic do this, and will I be faced with the same choice Talbot-Jones imposed on her clinic’s patients? Will I have to reckon with the consequences of either adding $400 to our monthly family budget, or losing the physicians and nurses who understand our medical histories?
A health system that doesn’t penalize or disincentivize doctors for partially converting clinics to members-only private boutiques will risk unleashing a wave of changeovers that affects hundreds of thousands of patients.
Enter the federal health department, and the Canada Health Act, the law supposed to enshrine public health care. Whereas other full-fledged private clinics operate in a grey area of legality, experts say the commingling of private and public service becomes more problematic.
“Health Canada 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 department told CBC on Tuesday. “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.”
At the pointy end of this stick, Ottawa could withhold funding if the province didn’t comply with this interpretation of the Health Act. In other words, the province cannot condone this clinic conversion or any others like it.
And the doctor at Marda Loop suggested others would be tempted to follow.
Talbot-Jones told CBC that because of high overhead and growing pressures, she and other clinics have considered exploring new economic models.
“A lot of doctors are facing bankruptcy in their clinics,” the doctor said. “I follow Facebook groups where lots of doctors all over the country, they’re all seeing the same thing.”
The College of Family Physicians of Canada voiced such a dual warning with its statement on Marda Loop:
“Charging patients for access goes against the principles of Canada Health Act, but is symptomatic of the pressures amid the crisis facing family doctors.”
The private-only boutique clinic model has been around for years, but has never taken off. Marda Loop’s hybrid solution, taking existing patient lists and demanding charges, stood to spread more widely, if permitted.
But it appears it won’t be permitted. A crackdown won’t somehow solve the crisis to the sustainability of family medicine, but it does prevent a potential new front to this crisis.
Health Canada says it has written to Alberta officials to inform them that the ability for patients “to purchase preferential access” at a Calgary clinic runs contrary to the Canada Health Act.
“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,” the government department wrote in an email.
On Monday, CBC News reported that a Calgary clinic had told its members that it would be moving to a membership model.
The pricing under that model, shared with CBC News, was listed as $4,800 per year for a two-parent family membership, covering two adults and their dependent children.
Other memberships included a $2,400-per-year membership that covers one adult and their dependent children, and $2,200 per year for an individual adult membership.
In the statement, Health Canada wrote that Canadians should have access to primary health care services based on medical need, and not on their ability or willingness to pay.
“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 statement reads.
Membership fees at private clinics are considered patient charges under the Canada Health Act and raise concerns under the accessibility requirement of the act, officials 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,” the statement reads.
In a joint statement issued later Tuesday, Premier Danielle Smith and Alberta Health Minister Adriana LaGrange said they’ve directed Alberta Health to investigate the clinic to ensure compliance with all legislation.
They said if any non-compliance with relevant legislation is found, appropriate action will be taken.
“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,” they said.
The Marda Loop clinic is not the only such clinic providing membership programs, in Calgary or in Canada.
Researchers from Dalhousie University and Simon Fraser University released a paper in 2022 which tracked the number of clinics taking private payment across the country.
At the time of the analysis — between November 2019 and June 2020 — there were 14 private clinics in Alberta with a range of membership fees and private payment. During that same period, there were 24 in Ontario and 30 in Quebec.
A spokesperson in the federal health ministry said other clinics in Calgary and Alberta charging membership fees could also expect such a response in the future.
Under the Canada Health Act, patients can’t be charged for “medically necessary” services that are provided in a hospital or by a doctor. If that happens, provinces that allow private health-care providers to do so will have dollars clawed back by the federal government.
“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,” Fiona Clement, a professor who specializes in health policy in the department of community health sciences at the University of Calgary, previously told CBC News.
“But what is being tried, and I think kind of skirting the bounds of what’s allowable, are these membership fees.”
Best CCTV Camera in Brampton
Fiona Clement, a professor at the University of Calgary in the department of community health sciences, says the biggest impact of a clinic transitioning to a membership model would be felt by the individuals who wouldn’t be equipped to afford it. (Riley Brandt/University of Calgary)
Cheap CCTV Camera in Brampton
Health Canada said in its statement that where there is evidence of patient charges, mandatory deductions to federal health transfer payments to the province or territory must be taken.
Prior to the Health Canada release on Tuesday, Alberta NDP Leader Rachel Notley said the decision made by the Marda Loop clinic “undermines the very values of public healthcare.”
“Public healthcare means every Albertan gets the care they need, when they need it and where they need it, regardless of the amount of money in their pocket,” Notley wrote.
Reached at her clinic Tuesday, Dr. Sally Talbot-Jones, owner and manager of the Marda Loop Medical Clinic, said it had taken her a year to reach the decision she did, citing struggles to meet overhead.
“We’re empathetic people. We want to look after patients. But at the end of the day, the bank doesn’t care that you’re empathetic,” she said. “And patients were actually asking for options.”
Talbot-Jones said such an arrangement enabled her to be able to look after people who were looking to secure access to extra appointments.
In response to the statement from Health Canada, Talbot-Jones noted that there are many private clinics in Calgary — many of which may not be advertising.
“This is not the first time it’s happened. I’m just, kind of, made this public at the wrong time, when people are upset,” she said.
Talbot-Jones said her clinic shouldn’t be considered in contravention of the Canada Health Act, because a membership clinic offers more than just health-care to its clients.
“I am just helping those people that need the extra time,” she said.
Home CCTV Camera in Brampton
Dr. Alika Lafontaine, president of the Canadian Medical Association, said public health systems are deteriorating nationwide. (Marni Kagan/CMA)
Best CCTV Camera in Brampton
Dr. Alika Lafontaine, president of the Canadian Medical Association, said that providing different levels of access to health services based on ability to pay can negatively impact patients who are in greatest need of care.
“We must also remember however that pay-out-of-pocket approaches become more prevalent as our public health systems deteriorate as we have seen nationwide,” Lafontaine wrote in a statement.
“Lack of investment, outdated incentives, and unhealthy working environments must be improved if we’re to have providers remain committed [to] our public health systems and to ensure that delivery provides adequate access to needed health services.”
The College of Family Physicians of Canada responded to the clinic’s move on social media.
“Charging patients for access goes against the principles of Canada Health Act, but is symptomatic of the pressures amid the crisis facing family doctors. Sustained investment into family medicine is crucial to ensuring accessible care for patients,” the college wrote.
Calgarian Robin Arseneault visited her doctor’s office in Marda Loop recently for a routine physical.
Along with her husband, Robert, the Arseneaults visit the neighbourhood clinic often. That’s because Robert has high medical needs as someone with primary progressive MS, heart and bladder dysfunction, diabetes and kidney concerns.
So the couple was surprised to see an email land from the Marda Loop Medical Clinic in their inbox that same week, stating that the clinic would be moving to a membership system.
The pricing under that membership, shared with CBC News by Arseneault, is listed as $4,800 per year for a two-parent family membership, which covers two adults and their dependent children.
Other memberships include a $2,400-per-year membership that covers one adult and their dependent children, and $2,200 per year for an individual adult membership.
“First off, we can’t afford $4,000 a year,” Arseneault said. “Secondly, I fundamentally disagree with that tiered system of health care. I can’t stand the idea that if I have more money, I get more privileged care, than say, my neighbour. It’s just against my beliefs.”
In return for the membership, the Marda Loop Medical Clinic promises reduced wait times and extended appointment times, among other benefits. The clinic also says it will continue to provide care one day a week for non-members.
CBC News was told an administrator at the clinic wasn’t available for an interview. In an email sent to the clinic’s members, Dr. Sally Talbot-Jones wrote that the clinic’s aim was to alleviate stress expressed by patients due to extended waiting times, the challenge of scheduling family appointments, and more.
“This decision was driven by my commitment to providing you with the level of care you deserve. I have extensively researched the most successful health care models around the world, and I am confident that our new program is designed to deliver excellence,” Talbot-Jones wrote.
The program at the Marda Loop clinic isn’t the first along these lines in Calgary. Such arrangements date back years and they aren’t all structured in the same way.
But as the Canadian and Alberta health-care systems struggle under the weight of increased pressure — whether that’s rural emergency room closures, ambulance shortages, or overwhelmed hospitals — experts say arrangements like the one being offered at the Marda Loop clinic are becoming increasingly common.
Back in 2008, Alberta’s health minister at the time was asked whether he had any concerns about a private clinic, the Copeman Healthcare Centre, opening up shop in downtown Calgary, charging $2,900 per year.
The clinics didn’t contravene the Canada Health Act because they didn’t charge patients for medically necessary services, CEO Don Copeman said at the time.
Given that, then-Alberta health minister Ron Liepert said there should be little need for such clinics if Alberta made changes to its publicly funded health-care system.
“The findings were that there was no contravention of the Canada Health Act so I wouldn’t be proposing to do any kind of review,” Liepert said.
The Canada Health Act stipulates that patients can’t be charged for “medically necessary” services, provided in a hospital or by a doctor.
There are some blurred lines here, though, when it comes to privatization in Canada.
Consider services like chiropractic services, which are not deemed medically necessary and aren’t covered in Alberta, meaning patients have to pay for those themselves or through private insurance.
If private health-care providers charge patients for medically necessary services, the provinces that allow that have dollars clawed back by the federal government.
“So, 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 who specializes in health policy in the department 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.”
Since the Copeman Healthcare Centre opened in 2008, many more such arrangements have followed — in Alberta and across the country.
In 2022, researchers from Dalhousie University and Simon Fraser University released a paper tracking the number of clinics taking private payment across the country.
At the time of the analysis, which was between November 2019 and June 2020, there were 14 private clinics in Alberta with a range of membership fees and private payment. During that same period, there were 24 in Ontario and 30 in Quebec.
“While reports have documented the operation of corporate or boutique clinics in Alberta and Ontario, we do not yet have national information on the extent of these practices,” the authors wrote in the report.
In any effort to document the number of such operations, there would be some error and misclassification involved, Clement noted, as there’s no formal registry list and no necessity to register this sort of approach.
There have been ebbs and flows in the conversation at a policy level about what to do about this issue, Clement noted, but added everyone’s a little bit hamstrung, as technically there’s nothing wrong with what’s happening.
“The college who deals with governing the professionals and making sure that doctors are adhering to their professional ethics, they’re still offering medically necessary care, and they’re not charging patients,” Clement said.
“So there’s technically no violation there. So, I really think it would have to come from the government to sort of ban these kinds of things.”
When the Copeman Healthcare Centre opened in 2008, a Calgary spokesperson with Friends of Medicare, a public health care advocacy group, bemoaned the trend. It questioned whether society wanted to allow people who have an “extra $3,000 to spend [to go] to the front of the line and everybody else can fall where they may.”
The group is increasingly concerned today.
Chris Gallaway, executive director of Friends of Medicare, believes such arrangements are “a violation of the Canada Health Act” and called for them to be investigated.
“We shouldn’t be creating two tiers, where some people pay to get into a certain clinic that others can’t access,” he said.
In a statement, a spokesperson with Alberta Health Minister Adriana LaGrange wrote that the government remains committed to the principles of the Canada Health Act, adding that Albertans don’t need to pay out of pocket for insured health services.
“All physicians must also follow standards of practice set by their regulatory colleges. The government will continue examine these cases to make sure all legislation is being followed,” Scott Johnston, press secretary for LaGrange, wrote in a statement.
The Alberta NDP held a media availability in Calgary on Monday to draw attention to the clinic’s decision to charge membership fees, saying it was “very concerned” other clinics might follow suit.
While the province says it will monitor developments, one health policy expert says it’s not surprising to see some doctors experiment with these kinds of solutions given the pressures they are under in terms of patient demand and rising financial costs.
“A combination of pressures related to increasing rental prices, and for increasing staff wages, as well as just general inflation in their daily lives, I think there is a pretty large pressure to increase revenues, however possible,” said Rosalie Wyonch, lead of the health policy research program at the C. D. Howe Institute public policy think tank.
In provinces across Canada, there is a lot of grey area about what makes up a full, publicly-insured service, what could what is definitely a private service, and what could be either-or, Wyonch noted.
“All of that uncertainty, it creates in some cases opportunities to generate revenue or improve access to services with some fees,” she said.
“It could also create equity concerns in terms of only being able to access services if you can afford one of these concierge services.”
In the midst of all this uncertainty, some patients like the Arseneaults worry they’ll be left behind, without many options in front of them.
“I mean, we enjoy our doctor, we get good services from the clinic. And, yeah, it’s a upsetting situation,” Arseneault said.
“It’s actually quite frightening. And it causes a lot of stress for us.”
Cheap CCTV Camera in Brampton
Home CCTV Camera in Brampton
Alberta’s health minister will review what functions Alberta Health Services performs, saying there are questions about whether the provincial health authority has become too large.
“It was originally intended to just look after acute care,” Health Minister Adriana LaGrange said in an interview with CBC News in Calgary on Tuesday.
“But now it looks after acute care. It looks after primary care. It’s looking after continuing care. It’s also a service provider. It’s also developing policy. All of these areas were beyond the scope it was originally intended for.”
Premier Danielle Smith released a hefty four-page health mandate letter on Tuesday, six weeks after LaGrange was sworn in as minister.
After four years as education minister, LaGrange is now charged with addressing health care recruitment and retention challenges across Alberta, including rural access to obstetricians, midwives and family doctors.
The premier also asked LaGrange to be willing to “reform the management and structure of Alberta Health Services (AHS) to better decentralize decision-making and resources to the front lines and local communities.”
Smith’s letter says the health system must welcome innovation and incentivize the best patient care.
In 2008, the Progressive Conservative government of the day created AHS by merging all regional health authorities and a handful of provincial health agencies.
It was the first provincewide health authority in Canada. More than 125,000 employees now work for AHS or one of its wholly owned subsidiaries.
Since pursuing the United Conservative Party leadership last year, Smith has said she wants to reform AHS to allow local leaders to act more quickly to start new programs or respond to local problems.
On Tuesday, LaGrange said she doesn’t want to presuppose the outcome of this reorganization, nor did she give a timeline for when the government would make restructuring decisions.
LaGrange ruled out the idea of hiring a consultant to conduct another analysis of the organization.
In 2020, the UCP government released the results of a $2-million AHS review performed by Ernst &Young, which recommended measures it said could save nearly $2 billion per year.
LaGrange said the time for studies is done, and the government will instead act on previous recommendations. However, closing or consolidating rural hospitals, as the EY review recommended, is not on her to-do list, LaGrange said.
Health-care union leaders, meanwhile, have raised concerns about restructuring a system that is already under strain from high patient demand, growing government expectations and a shortage of workers.
“Our health-care workers need stability and investment in the work they do every single day,” Health Sciences Association of Alberta president Mike Parker said on Tuesday. “Not conflict between a public health guarantee and alternative models. Not this unknown nebulous of decentralization.”
Although the UCP government has been outsourcing some functions of the health system to private companies, Smith has said no Albertan will have to pay out of pocket for insured health services, such as a family doctor visit.
NDP primary and rural health critic David Shepherd said the government’s pledge of decentralizing decision making is ironic, given Smith fired the AHS board and installed an administrator to speed up change.
“It’s a bit laughable that she’s suddenly now saying she wants to be more regional, collaborative and empower local healthcare workers and others,” Shepherd said. “I don’t think our system would be helped by creating additional red tape, additional boards.”
When asked, LaGrange didn’t say whether splitting AHS back into regional boards was a possibility.
Smith has also asked LaGrange to resolve “the unacceptable lab services delay challenge” as patients, particularly in Calgary and southern Alberta, are sometimes left waiting more than a month for routine tests.
During the last year, AHS has outsourced more lab testing to Dynalife, a company that was already running community labs in Edmonton and parts of northern Alberta. Privatizing more of the service was one of the EY report’s recommendations that was supposed to save money.
However, patients who depended on routine or timely tests sometimes spent hours waiting in emergency rooms instead to get their tests done on time.
LaGrange wouldn’t say what solutions the government is considering, but that officials have made it clear to Dynalife they expect the company to scale up its staffing and improve service.
“Albertans deserve the best lab services available,” she said. “And right now that’s not happening.”
She did not say what the consequences would be for Dynalife, should they continue to fail to meet expectations.
Dynalife deferred questions to Alberta Health.
HSAA represents around 3,000 lab workers across the province in both public and private labs.
Union president Parker said the service Dynalife provides has eroded because the company now needs to skim off profits for shareholders.
“How do you make those profits? It’s in cutting of resources, time, scheduling, workers,” he said.
Parker was happy to see the premier address worker concerns such as employee shortages in the mandate letter, saying unions have been pointing out the problem for years.
Among the rest of LaGrange’s to-do list is containing to try reducing surgical and emergency room wait times, addressing a taxed EMS system, and strategizing how to recruit and retain workers, especially in rural Alberta.
She’ll also implement UCP election promises to expand disease screening for newborns and bolster women’s health research.