The NDP government plans to introduce legislation this spring designed to prevent the further privatization of Alberta’s health-care system by banning extra billing at fee-based private clinics, leaked documents reveal.
CBC News has obtained a March 8 draft of the Protection of Public Health Care Act.
A political economist said while the draft bill tries to set boundaries for private clinics, it may not achieve its goal of ensuring a single-tier health-care system.
“I think it is a starting point for trying to regulate and control the private clinics and the extra billing concern,” said Trevor Harrison, a University of Lethbridge sociology professor who is also director of the Parkland Institute, which has studied this issue.
The bill would amend the Alberta Health Care Insurance Act to prohibit anyone from charging patients extra for insured services provided by a physician or dentist. Currently, the Act prohibits physician or dentists from extra billing, but it does not specifically prohibit other individuals from doing so.
The penalties remain unchanged: a fine of up to $10,000 for a first offence, and up to $20,000 for subsequent offences. But the bill would add a line saying a prosecution could not be started more than two years after the health minister learned of the alleged offence.
The bill would also specifically define a “block-billing fee,” the membership fee a private clinic charges in exchange for a patient’s access to its services.
Harrison said the challenge is “there is no way to definitively know that in fact, part of the membership fee went towards allowing people to jump the queue, in a sense, and get those same public (insured) services.”
“The clearest way to actually separate this altogether would be if the public system was genuinely covering all of the things that it says it is going to do,” he said, “and none of those insured services were being covered by the private clinics.”
If that was the case, Harrison said, “the private clinics could only survive by charging for those additional kinds of boutique services.”
The bill, if passed, would become effective immediately.
Fee-based private health organizations would not be liable if the insured service was provided in an emergency, or before the legislation came into effect.
On Wednesday, CBC News revealed the government intends to introduce several pieces of legislation, with this bill as the centrepiece, when the new session of the legislature begins March 18.
At a news conference that same day, Health Minister Sarah Hoffman confirmed her government was developing legislation to protect public health care, but did not provide details on its contents. Hoffman also would not confirm the legislation would be passed in a spring sitting of the legislature.
Government “committed to a single-tier” health system
The bill would add a lengthy preamble to the Alberta Health Care Insurance Act, stating that the government is committed to “a single-tier public health-care system that ensures access to necessary medical care based on need and not on the ability to pay.” It would also state the government is committed to prohibiting:
- “Two-tier medicine and extra billing and any other form of private payment in relation to insured services;
- “The provision of accelerated access or queue-jumping in relation to insured services by reason of a private payment;
- “Private insurance in relation to insured services.”
An internal government briefing from February obtained by CBC News provides more context on the proposed legislation.
“There are a number of [fee-based, private health organizations] operating in Alberta, which charge membership or other up-front fees for access to a package of insured and non-insured physician services, and non-insured services provided by other health professionals,” the document states.
The briefing is addressed to the NDP government’s spring legislation and policy committee, which is chaired by Hoffman.
Private clinics operate in gray area, internal document says
The briefing said Alberta Health is aware of 10 fee-based, private-health organizations operating in the province, and more than 17,000 Albertans received insured services from those clinics in 2018.
Currently, those clinics “are not subject to specific legislative requirements, similar to those of [non-hospital surgical facilities], whereby they require specific authorization from the minister to operate in Alberta,” the document said.
Instead, those fee-based organizations register with Alberta Health in the same way physicians’ offices do, the briefing stated. The clinics’ operators don’t have to disclose they will be running a fee-based private health organization “and do not require express authorization from the minister” to adopt that business model.
While the operation of those clinics can vary, the briefing said operators tend to charge a block-billing fee for a set of uninsured services, and also access to insured services performed by doctors in the same clinic.
Those doctors “are required to spend more time with patients and consequently see fewer patients,” the document said. The clinics’ patients often also get access to other health professionals, such as physical therapists and dietitians.
Harrison, the political economist, said is is difficult to determine the exact impact a bill like this would have on those private clinics.
“You don’t always know the effect until the rubber hits the road, and then you see where private health-care providers, in this case, find weak spots to go in again,” he said.
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Sherwood Park is a large hamlet in Alberta, Canada within Strathcona County that is recognized as an urban service area. It is located adjacent to the City of Edmonton’s eastern boundary, generally south of Highway 16 (Yellowhead Trail), west of Highway 21 and north of Highway 630 (Wye Road). Other portions of Sherwood Park extend beyond Yellowhead Trail and Wye Road, while Anthony Henday Drive (Highway 216) separates Refinery Row to the west from the balance of the hamlet to the east.
Sherwood Park was established in 1955 on farmland of the Smeltzer family, east of Edmonton. With a population of 70,618 in 2016, Sherwood Park has enough people to be Alberta’s seventh largest city, but technically retains the status of a hamlet. The Government of Alberta recognizes the Sherwood Park Urban Service Area as equivalent to a city.
Sherwood Park, originally named Campbelltown, was founded by John Hook Campbell and John Mitchell in 1953 when the Municipal District of Strathcona No. 83 approved their proposed development of a bedroom community east of Edmonton. The first homes within the community were marketed to the public in 1955. Canada Post intervened on the name of Campbelltown due to the existence of several other communities in Canada within the same name, so the community’s name was changed to Sherwood Park in 1956.
The Sherwood Park Urban Service Area is located in the Edmonton Capital Region along the western edge of central Strathcona County adjacent to the City of Edmonton. The majority of the community is bound by Highway 16 (Yellowhead Highway) to the north, Highway 21 to the east, Highway 630 (Wye Road) to the south, and Anthony Henday Drive (Highway 216) to the west. The Refinery Row portion of Sherwood Park is located across Anthony Henday Drive to the west, between Sherwood Park Freeway and Highway 16. Numerous developments fronting the south side of Wye Road, including Wye Gardens, Wye Crossing, Salisbury Village and the Estates of Sherwood Park, are also within the community. Lands north of Highway 16 and south of Township Road 534/Oldman Creek between Range Road 232 (Sherwood Drive) to the west and Highway 21 to the east are also within the Sherwood Park urban service area.