An Alberta medical clinic’s fee structure has a Saskatchewan family doctor raising a red flag on what he fears could be coming to the province.
Dr. Adam Ogieglo practices in Saskatoon and said family doctors who are stretched to the limit are looking for solutions to make working conditions more reasonable, but he doesn’t see a user-pay model as the answer.
The Marda Loop Medical Clinic in Calgary has informed patients by email that starting on Tuesday, it will still see patients for free one day a week, but 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 the 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.
“I think this is maybe a swing and a miss,” Ogieglo said.
He said this kind of pay structure, if it were to gain traction, would swamp emergency rooms much more than they already are.
“It would dramatically worsen access for everybody.”
Ogieglo said he can only speak for himself, but he doesn’t see family doctors actively wanting to filter out their practice based on who can afford an annual subscription fee.
“We need solutions to the primary care crisis and you’re going to see people get creative and bring in solutions like this.”
He said the option the clinic in Calgary brought in does save them from messy discussions with the government and negotiations over fee structures.
“It’s a relatively easy thing to do, and frankly I’m a bit surprised that it hasn’t really happened more.”
Ogieglo did say this situation was a little muddy though, noting the Canada Health Act says that you can’t charge for medically necessary services, but said clinics can skirt around that by offering non-medically necessary services like access to a dietician or a physiotherapist and bundling that with medically necessary services.
To give an example of how this would affect patients, Ogieglo said if he were to follow the same payment structure as the clinic in Calgary he’d be able to drop his patient roster from 1,600 down to just 160.
“The accessibility for those who are able to pay would improve dramatically, but it’s at the cost of those who are not able to pay.”
He said there’s nothing stopping this same kind of clinic structure from coming into Saskatchewan.
“The same working conditions that lead to this physician choosing to do that in Alberta exist in Saskatchewan. We’re still stuck within this fee-for-service payment scheme, which is badly outdated and needs to be changed urgently.”
He said the current pay structure doesn’t make sense with an aging population, more complex patients and more paperwork, noting family physicians in the province don’t get reimbursed for that extra work.
Health Canada says charging patients a fee to gain faster access to a family doctor would be violating Medicare laws.
The federal agency says it is working with the province on this and says Alberta risks losing federal health transfer payments if it doesn’t do something about it.
In a statement, Health Canada says the Marda Loop fee plan equates to preferential access to insured health services and, therefore, violates the universality provisions of the Canada Health Act.
Fiona Clement, a professor who specializes in health policy at the University of Calgary, said there have been membership-type clinics since 2008.
“It’s not a new idea, it’s not only in Alberta. There are clinics like this across the country,” she said.
Clement said Alberta’s response will be key.
“(The fee plan) really isn’t in the spirit of the Canada Health Act, but technically it’s not illegal,” she said. “It’s technically not a violation of the Canada Health Act, which is the federal government’s responsibility to enforce. It’s not a breach of ethics or professional practice, which is the College of Physicians and Surgeons’ responsibility to enforce on an individual physician level.”
The Saskatchewan government announced back in May that a blended capitation model for family doctors would be on its way.
Doctors will be able to get a base rate for a standard range of services for each patient, but will also get additional fee-for-service payments for extra services.
Health Minister Paul Merriman said in May that they hoped to have the new pay system in place within 12 months.
Global News has reached out to the Ministry of Health and received a statement.
“Based on the information available, this specific scenario would not be allowed in Saskatchewan per The Saskatchewan Medical Insurance Act. The Act does not permit a physician practicing in our publicly-funded health system to charge a ‘membership fee’ to Saskatchewan patients,” read the statement.
The ministry said it was monitoring the situation in Alberta.
“It is the goal of the Saskatchewan Ministry of Health is to ensure consistent, equitable, and appropriate delivery of high-quality health care for the people of Saskatchewan.”
– with files from The Canadian Press