'Concierge medicine' a controversial trend in Canada
CTV News.ca Staff
Published Tuesday, August 2, 2011 7:10PM EDT
For years now, some Canadian patients have been taking advantage of "concierge medicine" clinics, paying an annual fee for 24-hour access to a physician, nutritionists and other services.
While these clinics gets patients out of crowded emergency rooms and away from over-burdened family doctors, they may also run afoul of the Canada Health Act, which says user fees or extra charges must not impede access to health services.
Annette Aubrey is one of those patients who has been taking advantage of "concierge medicine." She says for years, she had been satisfied with the public health care system.
But after a recent unsuccessful search for a family doctor, she decided to pay $3,000 a year to Calgary clinic Provital Health Wellness.
For that fee, Aubrey can contact a doctor at any time of day or night, as well as have access to nutritionists, fitness experts, massage therapists and counsellors.
"I had a choice between three doctors," Aubrey told CTV News. "That's unheard of in the public system. It was very attractive."
"I feel that the major way I benefit from this kind of health care is that I have freedom and I have peace of mind but I also have a sense of empowerment and engagement in my own good health. And that feels really good. It feels really good to know that ultimately, the choices are mine."
Dr. Donovan Kreutzer, the medical director at Provital, says the business model, a mix of private and public health care, is an antidote to the costly alternatives, such as unnecessary emergency room visits by patients without a family doctor.
He says clinics such as his also give patients more quality time with their physicians and quicker access to needed services.
"No other industry do I know of where you get into a clinic, you sit down, you wait for two hours, you get in and you get five minutes of a professional's time," Kreutzer said.
In Whitby, Ont., pediatrician Dr. Karen Dockrill had been capping her patient load at her clinic Mom and Baby Depot, Health and Family Resource Centre, since 2006. For $1,500 a year, patients received round-the-clock access to a doctor or nurse as well as access to complementary services, such as massage therapists, chiropractors and dieticians.
The clinic didn't charge patients for necessary medical services; the provincial health insurance still paid the $32 doctors' fee for a visit. But by charging her patients an extra annual fee, she was able to offer them much longer appointments, ensuring that patients could take the time to talk with her and discuss their children's health issues.
But patients were not accepted into the clinic unless they paid the annual fee. That's where Dockrill ran into trouble.
After a parent complained, the Ontario College of Physicians and Surgeons threatened to pull Dockrill's licence. Instead, Dockrill agreed to stop charging the fee, but had to drop her patients' access to the extra complementary services.
But she still defends her practice. She believes that patients should be allowed to buy add-on medical services that go beyond insured services, if they choose.
"People argue that this is a pure divide of public vs. private health care and it definitely is not. It is a meld of the two, knowing that to sustain our public health care, we can't be everything to everybody," Dockrill says.
"I do not feel we're doing anything wrong or immoral," she insists.
Dockrill says she knows of other clinics that offer "concierge" services and they aren't being targeted by the College of Physicians.
"I feel very much that I'm being singled out as a person because my name was before them. What the College tells me is 'We don't have to deal with all those other clinics, your name came to us from a complaint, and our powers allow us to look at your entire service'," she says.
"I am clearly being made an example of, absolutely. The College has made it very clear that I am to be disciplined."
The debate over the future of Canada's universal health-care system is heating up as the current Health Accord between the federal government and the provinces nears its expiration date, and an aging population requires an increasing amount of care.
While "concierge" clinics have the potential to alleviate such problems as long wait lists for surgeries and diagnostic tests for some patients, many experts agree that such clinics allow those who can afford it to jump the queue.
Dr. Irfan Dhalla, a physician and health-care policy researcher at Toronto's St. Michael's Hospital, says the fact that "concierge" clinics offer special access to people who have more money fundamentally goes against something that most Canadians hold dear: universal access to medicine.
He also worries that whenever a doctor opens up a concierge clinic and limits the number of patients they take, they risk worsening the country's doctor shortage.
"We don't have enough family doctors in Canada as it is right now, and boutique medicine or concierge medicine will only make that problem worse," he told CTV News.
He believes that regulators have a right to step in.
"There's no doubt that the Canada Health Act was set up to avoid these kinds of circumstances, and if physicians have been able to find loopholes, then I think the onus is on provincial and federal governments to try and close those holes," Dhalla said.
With a report from CTV's medical specialist Avis Favaro and producer Elizabeth St. Philip