New legislation would curb health-care privatization, ban extra billing at private clinics

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 thoseinsured 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.

If you have information about this story, please contact us in confidence at cbcinvestigates@cbc.ca.

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