Lack of information, enforcement allows private health care clinics to blur public/private line

A new report released today by Parkland Institute reveals that private membership health care clinics in the province have for years blurred the line between private and public delivery due to a lack of information and inadequate enforcement tools to ensure they operate in compliance with the Canada Health Act.

Based on numerous freedom of information requests and analysis of a series of government audits, Blurred Lines: Private Membership Clinics and Public Health Care found a troubling absence of a central database or even the collection of information about these private clinics, which charge thousands of dollars per year in membership fees for combined physician and complementary practitioner care.

“Most Albertans would be shocked to discover how difficult it is to find even the most basic information about these clinics, including how many there are, how many patients they serve, and how much Albertans are spending on private medical services,” says Rebecca Graff-McRae, the report’s author. “While I was ultimately able to catalogue 33 fee-based private clinics in Alberta, government and accrediting bodies seem to have no interest in collecting and making available the information to allow adequate oversight of the operations of private clinics.”

The analysis of three audits of private membership clinics conducted by Alberta Health between 2011 and 2013 reveal a deeply flawed process restricted by extremely narrow scope, a focus on written clinic policies rather than actual practice, a lack of transparency, and a troubling absence of effective enforcement.

“It’s evident from the audit documentation that there are a number of dubious practices occurring at these clinics—including an unclear distinction between insured and uninsured services, extra-billing, and double-billing—which were not fully investigated because of the narrow focus on technical compliance with the Canada Health Act,” explains Graff-McRae. “Put simply, it’s difficult to find something you’re not looking for.”

Worse yet, Graff-McRae says that even when violations are identified there are few enforcement mechanisms available to government, and no financial penalty faced by the clinics themselves, and therefore no incentive to change their practices.

The report concludes with six recommendations to address these shortcomings, including closing legislative loopholes currently being exploited by these clinics; greater oversight by both the federal and provincial governments; the establishment of an independent ombuds office to address complaints by patients; and a more robust and transparent auditing process.

Parkland Institute is a non-partisan public policy research institute in the Faculty of Arts at the University of Alberta. Blurred Lines: Private Membership Clinics and Public Health Care is available for download.