Converting doctor's offices to premium clinics could spawn a new health-care crisis

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.

A 'transformative' model

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.

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.

Grey matter

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."

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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."

White Coat Black Art26:30ENCORE: Walk-in Clinic Pressure

Saskatchewan has lost so many of its family doctors in the last year that 200,000 "orphaned" patients are relying on walk-in clinics to get medical attention. Legends Medical Clinic in Warman is in the middle of the crisis, trying to meet the needs of all who seek their walk-in services but patients often wait for hours to see a doctor.

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.