NDP calls for probe into how many medical clinics are charging 'member' fees in Alberta

Alberta's New Democrats are calling for a province-wide probe to identify how many medical clinics could be charging membership fees, following a Health Canada notice this week that one Calgary clinic's plans to charge such fees ran afoul of the Canada Health Act.

But the governing United Conservative Party, which on Tuesday ordered an investigation into plans at the Marda Loop Medical Clinic in the city, says it is not aware of any other clinics offering services for membership fees that don't align with current legislation.

"If any other clinics begin to offer similar services for a membership fee, as Marda Loop has done, Alberta Health will undertake similar action," said Scott Johnston, a spokesperson for Alberta Health Minister Adriana LaGrange, in a statement to CBC News.

Last week, the Marda Loop Medical Clinic, located in southwest Calgary, sent a message to clients stating that it would be moving to a membership system, charging costs up to $4,800 for families.

That provoked pushback from Health Canada, and a subsequent joint statement from Premier Danielle Smith and LaGrange, who said they had directed Alberta Health to investigate the clinic to ensure compliance with all legislation.

Speaking at a press conference Wednesday, David Shepherd, the NDP's critic for health, said the UCP's plan didn't go far enough. 

"We believe there's evidence that members-only medicine is being offered in several clinics in Alberta, and we've only begun to dig into this issue," Shepherd said.

"The investigation into Marda Loop Medical Clinic is welcome. But we need a system-wide investigation — today."

During the press conference, the NDP mentioned a second Calgary clinic, located in the city's southwest, they said was offering a first-year cost for a "premier service" for $5,200, which included access to an onsite laboratory with "no-cost, expedited MRI and CT imaging when medically necessary."

CBC News has reached out to the clinic for comment. CBC has not confirmed such a fee structure exists at the clinic. 

A spokesperson with the provincial health ministry said the minister's office hadn't yet been briefed on that clinic, but added it was seeking more information.

Clinics offering private "concierge" services date back as far as 2006, including during the NDP's time in power. 

The party did introduce legislation during that period of time that was intended to halt such fees. But that was in mid-March 2019, when polls suggested they were just weeks away from defeat at the hands of Jason Kenney's United Conservatives.

When asked by reporters why the NDP didn't target these types of arrangements earlier in their term, Shepherd said when the NDP came into government they initiated an investigation to look into the issue.

"It took some time for that to work through. Unfortunately, that work was not completed in full by the time we reached the 2019 election," he said.

In a statement, the spokesperson with LaGrange's office said more details about the Marda Loop clinic investigation will be shared as they become available. He added that the provincial government remains committed to the principles of the Canada Health Act.

"Many of these clinics have operated in Alberta for decades, including while the NDP were in government, and do not offer preferential access for insured services," Scott Johnston wrote. 

Johnston said there are 13 known clinics operating in Alberta that fall into this category of offering uninsured services that are outside of the Canada Health Act and the health care insurance plan.

"As for other clinics that Alberta Health is aware of, the audit and compliance unit has evaluated instances where private clinics operate and provide services that are outside of the Canada Health Act in Alberta (uninsured services). All evaluations done to date have confirmed that these clinics are operating in compliance with the act," he wrote.

In a statement sent to CBC News on Wednesday, Health Canada said the membership model proposed by Marda Loop Medical Clinic, which included access to a mix of insured and uninsured health services, prompted the request for an investigation.

"Alberta Health has informed Health Canada it is currently investigating the Marda Loop Clinic's planned membership program to ensure compliance with all relevant legislation, including the Canada Health Act, and has committed to taking any needed action if non-compliance is found," the statement reads.

Researcher says Marda Loop clinic not only example

Researchers from Dalhousie University and Simon Fraser University released a paper in 2022 that suggested that there were 14 private clinics offering a range of membership fees and private payment between November 2019 and June 2020. Such clinics are also found across the country, including in Ontario, British Columbia and Quebec.

Ruth Lavergne, an associate professor in the department of family medicine at Dalhousie University and a Tier 2 Canada Research Chair in primary care, said what happened at the Marda Loop clinic was "striking" for a particular reason.

"This was an example of a place where people had been regularly getting primary care services, and then receiving the news that they would be asked to to pay out of pocket for registration," Lavergne said. "To my knowledge, that hasn't happened as commonly."

This is an area where there is a lot of uncertainty and a lack of clarity, making the decision from Health Canada very valuable, Lavergne said.

On Tuesday, CBC News spoke with Dr. Sally Talbot-Jones, owner of the Marda Loop Medical Clinic. She noted that there are many private clinics in Calgary, many of which may not be advertising.

That's true, Lavergne said, who suggested what would be valuable would be taking a closer look at the various private payment methods available for accessing primary care.

"It's definitely not unique to this clinic," she said.

The issue that could be in play here is that patients are not just paying for those additional services if a membership is required to receive regular primary care, Lavergne said.

"What I worry about here, and the issue that I would want attention to in this case, is that what we're talking about is paying to be able to get in the queue at all to be able to get your foot in the door," she said. 

"So I think the attention to what the implications are for being able to access regular primary care — and not simply the provision of other uninsured services — is what the central question is."

In its statement, Health Canada said executive and primary health clinics that charge patients enrollment and annual membership fees exist in a number of provinces.

"Health Canada has raised this issue as a concern under the Canada Health Act with provinces and asked them to investigate," the statement reads.

Health Canada added that the findings of these investigations have generally indicated that these clinics provide members with an array of uninsured services, such as life coaching and nutritional services.

"However, in some cases, as appears to be the case with the Marda Loop Medical Clinic, 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."