Subscription fees for medical services are part of a growing erosion of Canada’s public health care by the private sector.
The Minden emergency department in Ontario, Canada, which closed in June. (Steve Russell / Toronto Star via Getty Images)
A Calgary medical clinic’s plan to begin charging a subscription fee for basic health care services was so wildly unpopular that Premier Danielle Smith, who advocated for patients to pay out of pocket for doctor visits as recently as two years ago, put a stop to it. But the clinic’s proposal is part of a broader trend of private interests encroaching on Canada’s proud quasi-public health care system.
The Marda Loop Clinic, located in south-central Calgary, revealed its plan in a letter sent to patients in July. The clinic intends to shift from being a standard publicly insured facility to a membership-based service. This new approach would require patients to pay annual membership fees, granting them access to services for four days each week, while those facing financial constraints would be limited to just one day. The proposed fees ranged from $4,800 for a two-parent family, $2,400 for a single parent, and $2,200 for an individual, with the clinic promising shorter wait times and longer appointments for those who can afford it.
Clinic owner and manager Dr Sally Talbot-Jones cried poor when reached by CBC News for comment. “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, adding that patients offered to pay for expedited access. Talbot-Jones’s portrayal of a financially struggling business contrasts with her participation in a promotional video for a Porsche dealership, where she boasted about how much she loves her luxury car. After this author linked to the YouTube video on Twitter/X, it mysteriously went private.
Canada’s Public Health Care Isn’t Really Public
In Canada, the federal government provides health care funds to the provinces, who are responsible for how health care is delivered. Under the 1984 Canada Health Act, whose stated purpose is “to facilitate reasonable access to health services without financial or other barriers,” citizens cannot be charged for “medically necessary” health services. Nonetheless, significant coverage gaps persist, such as dental coverage, prescription medications, and mental health counseling.
The law grants the federal government the right to withhold a portion of health care payments if its conditions are breached. The federal authorities issued this threat to the Marda Loop Clinic, yet the Canadian Press wire service noted that it remains uncertain whether the “clinic’s fee plan is on hold or has been scrapped altogether.” Back in March, the feds clawed back $82 million in health care funds from eight provinces, including $13.78 million of Alberta’s funding. This action was taken in response to clinics charging patients for quicker access to insured services.
However, the act affords substantial leeway for privatization within Canada’s core health care framework. Physician clinics operate as private businesses, delivering services and subsequently invoicing the government instead of a private health insurer. These costs align with a payment structure outlined by their professional association, negotiated in collaboration with the provincial government of their jurisdiction. Furthermore, provinces are able to contract out hospital procedures to private, for-profit companies. The crucial caveat is that the public bears the expense, even if such privatization proves more costly for the government compared to conducting the procedures within the public system.
In Alberta, the government contracted out lab services to the private company DynaLIFE, a decision that was finalized last year. The lab system’s dysfunctionality prompted the province to declare its intention to regain public ownership by year-end, at an as yet unknown cost to the public. However, Premier Smith’s remarks on the matter strongly hint that this move may serve as only a temporary reprieve from broader privatization.
Prime Minister Justin Trudeau has praised the increasing role of private actors providing publicly funded health care, lauding it as a form of “innovation,” as long as it aligns with the Canada Health Act. “I have been saying for years that delivery of health care is the business . . . is the responsibility . . . of the provinces,” Trudeau said in an apparent Freudian slip. The Canadian health care system, in short, is likely not what American liberals and leftists have in mind when they sing its praises.
Cracks in the Public System
Despite lax restrictions on private health care delivery, clinics across Canada have gotten away with offering fees for publicly insured services for years. A 2022 study from Dalhousie University in Halifax and Simon Fraser University in Vancouver found there were eighty-three clinics offering publicly insured health care services for a fee across six Canadian provinces. Specifically, the breakdown comprised thirty clinics in Quebec, twenty-four in Ontario, fourteen in Alberta, thirteen in British Columbia, and one each in Nova Scotia and Newfoundland and Labrador.
“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,” CBC News columnist Jason Markusoff noted, likening the clinic’s practice to a renoviction, “in which a landlord evicts the apartment renters to renovate and sell the units as condos.” Dr Talbot-Jones conceded that while there are many private clinics in Calgary, she made a mistake by revealing her plans “when people are upset.”
The grey zone between public and private health care in Canada has been deftly exploited by private actors seeking to cash in on public funds and private largesse. “As health-care costs and wait lists grow, regulators are doing little to stop doctor-owned clinics from quietly and increasingly making patients pay for quicker access — for everything from appointments to surgery,” Kathy Tomlinson reported in a 2017 Globe and Mail investigation. Tomlinson’s report dates from three years before the pandemic exacerbated all health care challenges.
Out of 699 physicians working at seventy-one pay-to-play clinics, Tomlinson found that 68 percent of them also worked in the public system, allowing them to redirect patients from an increasingly overcrowded, underfunded public system to their boutique clinics. Often, the fees remained unadvertised, permitting these clinics to evade examination by provincial regulatory bodies. Those who were detected rarely faced any formal sanction.
The Copeman Healthcare Centre, which has locations in Calgary, Edmonton, and Vancouver, was found to have been billing both patients and the government for routine lab testing, leading patients to pay substantially more for the promise of enhanced access. The clinic then attempted to purge Athabasca Oil employees whose bosses stopped paying for their membership. The clinics were purchased in 2018 by Telus Health, a subsidiary of Alberta’s formerly public telecommunications provider, which continues to operate while charging membership fees for medical necessities.
In the earliest days of the pandemic, Alberta’s government promoted Telus Health’s Babylon virtual health care app as a way for patients to receive routine medical care while abiding by physical distancing restrictions. The province’s privacy commissioner found that the app violated patients’ privacy by collecting excessive data, including photos, and used facial recognition software without notifying them. “It seems as if they are putting their business model before the privacy of Albertans,” University of Alberta health law expert Ubaka Ogbogu told the CBC, noting a lack of safeguards against monetizing patients’ data.
Canada’s public health care system, which has faced decades of cuts from Liberal and Conservative governments alike, is increasingly plagued by excessive wait times and low staff retention. This has allowed for-profit actors to swoop in to earn government subsidies for their moneymaking schemes, demonstrating the shortcomings of existing Canadian public health legislation. Advocates for a single-payer health care system in the United States should take note, as Canada’s public health care experiences a slow erosion due to its internal contradictions.Original post