Lack of information and weak enforcement let private health care clinics fudge public-private health-care line

PHOTO: Parkland Institute researcher Dr. Rebecca Graff-McRae. Below: The cover of the Parkland Institute Report, Blurred Lines, Private Membership Clinics and Public Health Care.

It doesn’t exactly come as a surprise that so-called “private membership health care clinics” in Alberta have been fudging the line between public and private health care for years, using poorly drafted legal enforcement tools, lackadaisical application of the law, and a profound absence of transparency to get away with it.

The idea, basically, has been to provide higher-cost, higher-tier private health care to wealthy folks despite the fact such services violate the Canada Health Act while, in some cases, getting ordinary taxpayers to pay the freight by billing back as much as possible to the province’s public health care system.

Another ever-present ideological goal by advocates and operators of private clinics has been to get a toe in the door for more and more privatization of health care.

One common dodge has been the claim that the clinics only charge their well-heeled clients fees running to thousands of dollars per year for extras – diet advice, therapeutic massages and the like – and that the health-insurance-covered medical services such clinics offer are still part of the public system. Try walking into one of these places with your sick kid and no membership card to see how much truth there is to that story.

Given the right-wing provincial governments we have had in Alberta throughout recent and not-so-recent history, it also shouldn’t astonish anyone this medical-financial sleight-of-hand has been aided and abetted by lax enforcement of pathetically weak rules.

So it was reassuring in a weird way to see in black and white how the system was set up to be gamed in a report released this morning by the University of Alberta-based Parkland Institute, Blurred Lines, Private Membership Clinics and Public Health Care.

Researcher Rebecca Graff-McRae found what the Parkland Institute calls “a troubling absence” of any central database about the private clinics, or even any effort to collect information about what they’re up to.

“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,” she said.

Eventually, she explained, she was able to find 33 such private fee-based clinics in Alberta. Alas, she noted, “government and accrediting bodies seem to have no interest in making available the information to allow adequate oversight of the operations of private clinics.”

This is what can happen, perhaps, when voters change a government after one party has been in power far too long, but the senior civil service put in place by the former government remains comfortably ensconced in administrative power.

Dr. Graff-McRae looked in detail at three audits of private for-fee clinics done by Alberta Health (the government ministry, that is, not the public health care delivery agency with a similar name) between 2011 and 2013. They revealed “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.”

Nevertheless, what documentation there was made it obvious “a number of dubious practices” were going on at the clinics. These included a lack of distinction between insured and uninsured services, plus illegal extra-billing and double-billing. These practices didn’t get investigated because of “the narrow focus on technical compliance with the Canada Health Act,” she said.

“It’s difficult to find something you’re not looking for,” Dr. Graff-McRae observed – and, sure enough, Alberta’s health care authorities didn’t find it.

Right wing governments and their ideological echo chamber in Thinktankistan and the media can be depended on to defend such practices as offering more “choice,” as if health care were just another entertainment activity or fashion preference, and on the spurious grounds that taking well-off patients out of the health care system will reduce pressure on the system to help the rest of us.

As is well known, however, such policies do not deliver their advertised benefits. For example, parallel private systems actually increase wait times in the public system, Dr. Graff-McRae pointed out, as the private system drains the public system of human resources. Moreover, as we have seen in the not-so-distant Alberta past, they enable well-off patients to jump the queue for diagnostic services.

The 2013 inquiry into preferential access to health care services in Alberta ordered by Progressive Conservative premier Alison Redford found queue jumping was a reality in Alberta health care.

In the final report of the Health Services Preferential Access Inquiry, retired Justice John Vertes found that a public colon-cancer screening centre in Calgary provided improper preferential access to patients of a private clinic that charged members $10,000 a year for health care services.

Cherry picking healthy patients and adopting “market solutions” also make the entire publicly supported system much more expensive – as in the United States, where the government spends 23 per cent more per capita than in Canada while leaving millions uninsured.

As for “choice,” you only have it, of course, if you’ve got the money to pay for it.

The Parkland report includes six recommendations to address the private clinics’ practices in Alberta:

1. Close the provincial and federal legislative loopholes that are exploited by these private clinics
2. Exercise greater provincial oversight and regulation of members-only and fee-based clinics
3. Establish an independent investigation and complaints office to ensure improper activities are reviewed and enforced impartially
4. Implement a more comprehensive and transparent and audit process
5. Improve data collection and implement mandatory reporting by private clinics
6. Provide explicit support to the public system to help it increase efficiency in delivering high-demand services such as diagnostic imaging, for example, by replacing the fee-for-service model in ways that encourage collaborative care.