Alberta’s health ministry says an audit has determined that more than 40 medical clinics in the province are advertising membership fees for services, nearly a year after one such plan landed a Calgary clinic in hot water.
The audit was launched last December. In July, CBC News reported that a medical clinic in Calgary’s Marda Loop district was moving to a membership system and planned to charge $4,800 a year for a two-parent family membership, covering two adults and their dependent children.
The next day, Health Canada said the arrangement at the Marda Loop Medical Clinic equated to patients purchasing “preferential access” and warned Alberta that it could face cuts to federal health transfers if the situation wasn’t handled.
In December, LaGrange told CBC News that “appropriate action” would be taken if audits determined that violations were found, adding the province would do whatever it took to ensure clinics were in compliance.
Speaking at a news conference in July 2023, Alberta Premier Danielle Smith said the Marda Loop Medical Clinic would be fined, lose medicare funding or be shut down altogether if it proceeded with a plan to charge membership fees. (CBC)
The province promised the audits early in the new year. Now, the health ministry says it has conducted interviews to gather information on operations and business models of the clinics, adding this work is ongoing.
“Over 40 clinics in the province [advertise] a membership meant to pay for a defined set of uninsured services, while also providing insured services covered under the Alberta Health Care Insurance Plan at no cost to Albertans,” wrote spokesperson Andrea Smith in a statement.
“Once this review is completed, its findings will be used to inform next steps. Alberta’s government will also determine if additional audits of more membership clinics is required.”
In July, Health Canada said executive and primary health clinics charging patients enrolment and annual membership fees exist in a number of provinces. Generally, investigations have indicated that clinics provide members with an variety of uninsured services, such as life coaching and nutritional services.
“However, in some cases … 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,” the government department wrote in a statement.
A spokesperson for LaGrange told CBC News in July the ministry wasn’t aware of any other clinics offering services for membership fees that didn’t align with legislation.
What comes next for those 40 clinics is a murky grey area, said Fiona Clement, a professor at the University of Calgary in the department of community health sciences. Much of it has to do with the exact language being used when services are outlined as parts of packages.
“We’re on the razor’s edge of exact wording there that runs them afoul. Really, I think it will come down to what the government is willing to fight with these clinics about,” she said.
CBC News asked the provincial government for a list of the clinics identified, but did not receive it by publication time. A spokesperson with the province said if any clinics are found to be non-compliant with legislation, appropriate action would be taken.
Report had identified 14 clinics
Clement said the big issue that got the Marda Loop Medical Clinic in hot water was the concept of guaranteed access.
“That’s the problem that Marda Loop got into, because there you are charging access to medical care, which is the part that contravenes the Canada Health Act,” Clement said.
At the time the Marda Loop clinic fell under scrutiny, it was clear there were other such clinics providing membership programs, in Calgary and Canada.
In 2022, researchers from Dalhousie University and Simon Fraser University released a paper tracking the number of clinics taking private payment across the country. Between November 2019 and June 2020, the period of the analysis, there were 14 private clinics in Alberta with a range of membership fees and private payment.
Fiona Clement, a professor at the University of Calgary in the department of community health sciences, says she hopes to see an ongoing review tied to Alberta clinics charging membership fees made publicly available. (Riley Brandt/University of Calgary)
“So, 40 is a larger number than I was expecting. And I think it speaks to growth in this area, the number of clinics that are charging fees for different parts of care,” Clement said.
“I think it underscores the lack of stability, and the need to really think about how we’re funding primary care, because more and more clinics are turning to this private charge as a revenue source to keep the doors open.”
Provinces that allow private health-care providers to charge patients for medically necessary services have dollars clawed back by the federal government under the Canada Health Act.
According to Health Canada, Alberta was subject to a $20,450,175 deduction to its Canada Health Transfer payment in March 2024 under the diagnostic services policy. That’s up from $13,781,152 last year.
But the province received $20,538,796 in partial reimbursements tied to its March 2023 and 2024 deductions, which represents actions that Alberta Health has taken to limit patient pay for publicly funded goods or services, according to Clement.
“I guess we’re making some progress. But it’s still a big number, which says there’s still a lot of patient billing going on,” she said.
VANCOUVER – Contract negotiations resume today in Vancouver in a labour dispute that has paralyzed container cargo shipping at British Columbia’s ports since Monday.
The BC Maritime Employers Association and International Longshore and Warehouse Union Local 514 are scheduled to meet for the next three days in mediated talks to try to break a deadlock in negotiations.
The union, which represents more than 700 longshore supervisors at ports, including Vancouver, Prince Rupert and Nanaimo, has been without a contract since March last year.
The latest talks come after employers locked out workers in response to what it said was “strike activity” by union members.
The start of the lockout was then followed by several days of no engagement between the two parties, prompting federal Labour Minister Steven MacKinnon to speak with leaders on both sides, asking them to restart talks.
MacKinnon had said that the talks were “progressing at an insufficient pace, indicating a concerning absence of urgency from the parties involved” — a sentiment echoed by several business groups across Canada.
In a joint letter, more than 100 organizations, including the Canadian Chamber of Commerce, Business Council of Canada and associations representing industries from automotive and fertilizer to retail and mining, urged the government to do whatever it takes to end the work stoppage.
“While we acknowledge efforts to continue with mediation, parties have not been able to come to a negotiated agreement,” the letter says. “So, the federal government must take decisive action, using every tool at its disposal to resolve this dispute and limit the damage caused by this disruption.
“We simply cannot afford to once again put Canadian businesses at risk, which in turn puts Canadian livelihoods at risk.”
In the meantime, the union says it has filed a complaint to the Canada Industrial Relations Board against the employers, alleging the association threatened to pull existing conditions out of the last contract in direct contact with its members.
“The BCMEA is trying to undermine the union by attempting to turn members against its democratically elected leadership and bargaining committee — despite the fact that the BCMEA knows full well we received a 96 per cent mandate to take job action if needed,” union president Frank Morena said in a statement.
The employers have responded by calling the complaint “another meritless claim,” adding the final offer to the union that includes a 19.2 per cent wage increase over a four-year term remains on the table.
“The final offer has been on the table for over a week and represents a fair and balanced proposal for employees, and if accepted would end this dispute,” the employers’ statement says. “The offer does not require any concessions from the union.”
The union says the offer does not address the key issue of staffing requirement at the terminals as the port introduces more automation to cargo loading and unloading, which could potentially require fewer workers to operate than older systems.
The Port of Vancouver is the largest in Canada and has seen a number of labour disruptions, including two instances involving the rail and grain storage sectors earlier this year.
A 13-day strike by another group of workers at the port last year resulted in the disruption of a significant amount of shipping and trade.
This report by The Canadian Press was first published Nov. 9, 2024.
The Royal Canadian Legion says a new partnership with e-commerce giant Amazon is helping boost its veterans’ fund, and will hopefully expand its donor base in the digital world.
Since the Oct. 25 launch of its Amazon.ca storefront, the legion says it has received nearly 10,000 orders for poppies.
Online shoppers can order lapel poppies on Amazon in exchange for donations or buy items such as “We Remember” lawn signs, Remembrance Day pins and other accessories, with all proceeds going to the legion’s Poppy Trust Fund for Canadian veterans and their families.
Nujma Bond, the legion’s national spokesperson, said the organization sees this move as keeping up with modern purchasing habits.
“As the world around us evolves we have been looking at different ways to distribute poppies and to make it easier for people to access them,” she said in an interview.
“This is definitely a way to reach a wider number of Canadians of all ages. And certainly younger Canadians are much more active on the web, on social media in general, so we’re also engaging in that way.”
Al Plume, a member of a legion branch in Trenton, Ont., said the online store can also help with outreach to veterans who are far from home.
“For veterans that are overseas and are away, (or) can’t get to a store they can order them online, it’s Amazon.” Plume said.
Plume spent 35 years in the military with the Royal Engineers, and retired eight years ago. He said making sure veterans are looked after is his passion.
“I’ve seen the struggles that our veterans have had with Veterans Affairs … and that’s why I got involved, with making sure that the people get to them and help the veterans with their paperwork.”
But the message about the Amazon storefront didn’t appear to reach all of the legion’s locations, with volunteers at Branch 179 on Vancouver’s Commercial Drive saying they hadn’t heard about the online push.
Holly Paddon, the branch’s poppy campaign co-ordinator and bartender, said the Amazon partnership never came up in meetings with other legion volunteers and officials.
“I work at the legion, I work with the Vancouver poppy office and I go to the meetings for the Vancouver poppy campaign — which includes all the legions in Vancouver — and not once has this been mentioned,” she said.
Paddon said the initiative is a great idea, but she would like to have known more about it.
The legion also sells a larger collection of items at poppystore.ca.
This report by The Canadian Press was first published Nov. 9, 2024.
