Concierge Medicine Clinics Breaking the Norms of Canada Health Act
Submitted by Nimisha Sachdev on Wed, 08/03/2011 – 06:35 | Source:

There are lots of benefits of “concierge medicine” clinics but the main problem to avail this is the cost, as it is quite expensive.

Patients opt for these clinics as they provide 24- hour access to doctors, dieticians, massage therapists, psychologists and other health care workers, and for that, they have to pay annual fee of $3,500.

These clinics get patients which opt out of crowded emergency rooms and away from over-burdened family doctors. Annette Aubrey shared her experience that after a recent unsuccessful search for a family doctor, she decided to pay $3,000 a year to Calgary clinic Provital Health Wellness. She further affirmed that now, she has got peace of mind, but also a sense of empowerment and engagement for her own good health.

Dr. Donovan Kreutzer, the Medical Director at Provital, said: “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”.

But patients are not entertained unless they pay for the annual fee, and on this, a parent complained, the Ontario College of Physicians and Surgeons, to pull Dockrill’s license, where his son was getting medical services.

Even these clinics are breaking the norms, set by the Canada Health Act, which has asked clinics not to charge hefty amount from patients.

‘Concierge medicine’ a controversial trend in Canada

Source: CTV Staff | With a report from CTV’s medical specialist Avis Favaro and producer Elizabeth St. Philip


Tue. Aug. 2 2011 8:20 AM ET – 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.

Concierge mĂ©decine” une tendance controversĂ©e au Canada

Source: CTV Personnel | Avec un rapport de CTV médecin spécialiste Avis Favaro et producteur Elizabeth St. Philip


Tue. Aug. 2 2011 8:20 AM ET – Depuis des annĂ©es, certains patients canadiens ont profitĂ© de la «concierge mĂ©decine” cliniques, en payant une cotisation annuelle de 24 heures d’accès Ă  un mĂ©decin, nutritionnistes et autres services.

Bien que ces cliniques obtient les patients des salles d’urgence bondĂ©es et loin des mĂ©decins de famille surchargĂ©s, ils peuvent aussi contrevenir Ă  la Loi canadienne sur la santĂ©, qui dit des frais d’utilisation ou des frais supplĂ©mentaires ne doivent pas entraver l’accès aux services de santĂ©.

Annette Aubrey est un de ces patients qui ont pris avantage de la «mĂ©decine concierge.” Elle dit pendant des annĂ©es, elle avait Ă©tĂ© satisfait du système de soins de santĂ© publique.

Mais après une recherche récente infructueuses pour un médecin de famille, elle a décidé de payer 3000 $ par année à Calgary Wellness Clinic Health Provital.

Pour cette taxe, Aubrey pouvez contacter un mĂ©decin Ă  toute heure du jour ou de nuit, ainsi que l’accès Ă  des nutritionnistes, experts en conditionnement physique, des massothĂ©rapeutes et des conseillers.

«J’avais le choix entre trois mĂ©decins”, a dĂ©clarĂ© Ă  CTV Nouvelles Aubrey. «C’est du jamais vu dans le système public. Il Ă©tait très attrayante.”

«Je pense que le principal moyen-je bĂ©nĂ©ficier de ce type de soins de santĂ©, c’est que j’ai la libertĂ© et j’ai la paix de l’esprit, mais j’ai aussi un sentiment d’autonomie et l’engagement dans ma bonne santĂ© propres. Et cela se sent vraiment bien. Il se sent vraiment bon de savoir que finalement, les choix sont les miens. ”

Le Dr Donovan Kreutzer, le directeur mĂ©dical de Provital, dit le modèle d’affaires, un mĂ©lange de soins de santĂ© publics et privĂ©s, est un antidote Ă  des alternatives coĂ»teuses, telles que des visites inutiles aux urgences par les patients sans mĂ©decin de famille.

Il dit des cliniques comme la sienne aussi donner aux patients plus de temps de qualité avec leurs médecins et un accès plus rapide aux services requis.

“Aucune autre industrie que je sais d’oĂą vous entrez dans une clinique, vous vous asseyez, vous attendez pendant deux heures, vous obtenez Ă  l’intĂ©rieur et vous obtenez cinq minutes d’un professionnel Ă  temps”, a dĂ©clarĂ© Ă  Kreutzer.

Dans Whitby, Ont., PĂ©diatre Dr Karen Dockrill avait Ă©tĂ© plafonnement sa charge patient Ă  sa maman clinique et centre de ressources BĂ©bĂ© Depot, santĂ© et famille, depuis 2006. Pour 1500 $ par annĂ©e, les patients ont reçu rond-le-horloge de l’accès Ă  un mĂ©decin ou une infirmière ainsi que l’accès Ă  des services complĂ©mentaires, tels que les massothĂ©rapeutes, les chiropraticiens et les diĂ©tĂ©ticiens.

La clinique n’a pas fait payer les patients pour les services mĂ©dicaux nĂ©cessaires; l’assurance-maladie provincial encore payĂ© les honoraires du mĂ©decin 32 $ »pour une visite. Mais en facturant Ă  ses patients un supplĂ©ment annuel, elle Ă©tait capable de leur offrir des rendez-vous beaucoup plus de temps, s’assurer que les patients pouvaient prendre le temps de parler avec elle et discuter des problèmes de santĂ© de leurs enfants.

Mais les patients ne sont pas acceptĂ©s dans la clinique Ă  moins de payer la cotisation annuelle. C’est lĂ  que Dockrill connu des difficultĂ©s.

Après un parent s’est plaint, le Collège ontarien des mĂ©decins et chirurgiens menacĂ© de se retirer de licence de Dockrill. Au lieu de cela, Dockrill acceptĂ© de cesser de facturer les frais, mais a dĂ» abandonner ses patients l’accès Ă  des services supplĂ©mentaires complĂ©mentaires.

Mais elle dĂ©fend toujours sa pratique. Elle croit que les patients doivent ĂŞtre autorisĂ©s Ă  acheter des add-on des services mĂ©dicaux qui vont au-delĂ  des services assurĂ©s, s’ils le souhaitent.

«Les gens affirment que cette fracture est pur de soins de santĂ© publics vs privĂ©s et il est certainement pas. C’est un meld des deux, sachant que pour maintenir notre système de santĂ© publique, nous ne pouvons pas ĂŞtre tout pour tout le monde,” Dockrill dit.

«Je ne vous sentez pas que nous faisons quelque chose de mal ou immoral», elle insiste.

Dockrill dit qu’elle sait des autres cliniques qui offrent des «concierge» des services et qu’ils ne sont pas ciblĂ©s par le Collège des mĂ©decins.

“Je me sens très bien que je suis pris pour cible en tant que personne parce que mon nom Ă©tait devant eux. Ce que le Collège me dit est« Nous n’avons pas Ă  traiter avec tous ceux d’autres cliniques, votre nom est venu nous d’une plainte , et nos pouvoirs nous permettent de regarder Ă  votre service toute “, dit-elle.

«Je suis clairement faite un exemple d’, absolument. Le collège a Ă©tĂ© très clair que je suis d’ĂŞtre disciplinĂ©.”

Le dĂ©bat sur l’avenir du Canada universelle du système de santĂ© se rĂ©chauffe comme la Accord sur la santĂ© actuelle entre le gouvernement fĂ©dĂ©ral et les provinces se rapproche de sa date d’expiration, et une population vieillissante nĂ©cessite une quantitĂ© croissante de soins.

Alors que “concierge” cliniques ont le potentiel pour attĂ©nuer les problèmes tels que les listes d’attente pour les chirurgies longues et des tests de diagnostic pour certains patients, de nombreux experts conviennent que ces cliniques permettent Ă  ceux qui peuvent se le permettre de sauter la file d’attente.

Le Dr Irfan Dhalla, mĂ©decin et chercheur en politiques de soins de santĂ© Ă  l’HĂ´pital St. Michael de Toronto, affirme que “concierge” cliniques offrent un accès spĂ©cial Ă  des gens qui ont plus d’argent va fondamentalement Ă  l’encontre chose que la plupart des Canadiens sont chères: l’accès universel aux mĂ©decine.

Il s’inquiète aussi que chaque fois que le mĂ©decin ouvre une clinique de conciergerie et limite le nombre de patients qu’ils prennent, ils risquent d’aggraver la pĂ©nurie de mĂ©decins du pays.

“Nous n’avons pas assez de mĂ©decins de famille au Canada comme il est juste maintenant, et la mĂ©decine ou la mĂ©decine boutique de conciergerie ne fera que rendre le problème pire encore,” at-il dĂ©clarĂ© Ă  CTV Nouvelles.

Il croit que les rĂ©gulateurs ont un droit Ă  l’Ă©tape po

«Il ne fait aucun doute que la Loi sur la santĂ© a Ă©tĂ© mis en place pour Ă©viter ce genre de circonstances, et si les mĂ©decins ont rĂ©ussi Ă  trouver des Ă©chappatoires, alors je pense qu’il incombe aux gouvernements provincial et fĂ©dĂ©ral pour tenter de combler ces trous,” Dhalla dit .


Should expensive ‘concierge medicine’ clinics be allowed in Canada?

August 2, 2011 3:59 PM | By Community Team | Source: CBCNews |

“Concierge medicine” clinics that charge monthly fees for 24-hour access to doctors and other health practitioners are raising questions about whether such services are allowed under the Canada Health Act.

The high annual fee, $3,500 in the case of one Calgary clinic, pays for unlimited access to dietitians, massage therapists, psychologists and other health care workers whose services are generally not paid for by the provinces.

However, the clinics also limit the number of patients per doctor and offer 24/7 telephone and email access to doctors.

CTV reported Tuesday about concierge clinics in Calgary and Whitby, Ont. The Whitby clinic had to stop charging after a patient complained to the Ontario College of Physicians and Surgeons.

Dr. Donovan Kreutzer, medical director at Provital Health Wellness in Calgary spoke to CBC Radio’s White Coat, Black Art in March about why he started the concierge clinic in 2009.

“We got to a point where I was not able to … practice the medicine I wanted to practice,” said Kreutzer. “I wasn’t seeing anything from the government side that was ground-shattering.”

However, Diana Gibson of the University of Alberta’s Parkland Institute research network said that private clinics with fewer patients per doctor threaten the public health care system.

“It actually undermines the public system if you have a shortage of doctors because what they’re doing is reducing the number of doctor-hours available across the system per patient,” she says.


Faut-cliniques coĂ»teuses “mĂ©decine concierge ‘ĂŞtre autorisĂ©s au Canada?

2 août 2011 15h59 | Par équipe communautaire | Source: CBCNews |

“Concierge mĂ©decine” cliniques qui facturent des frais mensuels pour 24 heures d’accès aux mĂ©decins et autres professionnels de santĂ© soulèvent des questions quant Ă  savoir si ces services sont autorisĂ©s en vertu de la Loi de SantĂ© Canada.

Les frais annuels Ă©levĂ©s, 3500 $ dans le cas d’une clinique de Calgary, paie pour un accès illimitĂ© Ă  des diĂ©tĂ©tistes, des massothĂ©rapeutes, des psychologues et autres travailleurs des soins de santĂ© dont les services ne sont gĂ©nĂ©ralement pas payĂ©s par les provinces. Toutefois, les cliniques aussi limiter le nombre de patients par mĂ©decin et offre 24 / 7 par tĂ©lĂ©phone et accès au courrier Ă©lectronique pour les mĂ©decins.

CTV a rapportĂ© mardi sur les cliniques de conciergerie Ă  Calgary et Ă  Whitby, Ont. La clinique de Whitby a dĂ» arrĂŞter la charge, après un patient s’est plaint Ă  l’Ontario College des mĂ©decins et chirurgiens.

Le Dr Donovan Kreutzer, directeur médical au bien-être Santé Provital à Calgary a parlé à la blouse blanche de CBC Radio, art noir Mars pourquoi il a commencé à la clinique de concierge en 2009.

“Nous sommes arrivĂ©s Ă  un point oĂą je n’Ă©tais pas capable de … la pratique de la mĂ©decine, je voulais pratiquer», a dĂ©clarĂ© Ă  Kreutzer. «Je ne voyais pas quoi que ce soit du cĂ´tĂ© du gouvernement qui Ă©tait au sol bouleversante.”

Toutefois, Diana Gibson de l’UniversitĂ© de l’Alberta Parkland Institute rĂ©seau de recherche a dĂ©clarĂ© que les cliniques privĂ©es avec moins de patients par mĂ©decin de menacer le système de santĂ© public.

«Elle sape en fait le système public si vous avez une pĂ©nurie de mĂ©decins, car ce qu’ils font est de rĂ©duire le nombre de mĂ©decin-heure disponible Ă  travers le système par patient», dit-elle.

March 21, 2011 |
Concierge Medicine Talk Heats Up
In Canada

Dr. Brian Goldman hosted an online radio interview on Friday, March 11, 2011 together with Live Right Now, Sirius Satellite Radio Channel 137 and CBC’s initiative to help Canadians live healthier. Dr. Goldman interviews one Canadian physician who is operating a successful concierge practice in Canada and has found a legal way to work and operate around The Canada Health Act.

Concierge Mailbag

This week’s show on concierge medicine generated a strong difference of opinion from you. Provital Health & Wellness, based in Edmonton is one such clinic. Provital charges paying patients an annual membership fee of $3500. The high annual fee is usually justified on the basis that the fee pays for unlimited access to dieticians, massage therapists, psychologists and other health care workers whose services are generally not paid for by the provinces.

Some of you wrote in to express your disapproval for concierge medical clinics.

“I have to be honest that I was quite angry listening to your interview with the doctor running the clinic in Calgary. I lived in Calgary for 10 years and had access to a family physician for only 3 of those years. I am quite sure that the surge in private medicine in that city has reduced the number of doctors available to the public. Taxpayers’ money is going into the public system, so why should I have to pay a couple of thousand dollars a year to gain access to doctors that should be in the public system anyway? Unacceptable.” From: Kathleen Matthews, Toronto

“Privatization CAN’T be the only answer here. You privatize healthcare, then it’s the schools, the police forces and so on. None of that gated-community mentality is a useful Canadian solution. I don’t want to leave anybody behind, but I don’t want to be lying there unable to even dial 911 by myself (as is the case occasionally) with no system in place to support me. Government: figure this out; balance our legitimate corporate priorities with the needs of real human beings in a fair and equitable arrangement, and stop relying on dogmatic free-market hocus-pocus to magically come up with the answers.” From: Peter Brown, Toronto

“I am incensed at the notion of concierge medicine. It does deplete the pool of physicians available to the public health care system. It is both unethical and immoral, because it amounts to might makes right. It is selfishness to the detriment of all of us. It is an example of the general malaise of narcissism that has afflicted North America in the past 15 years or so. Narcissism is a sickness that tells people so deluded that they are so much more important, valuable, and worthwhile than others that they deserve first consideration. Yet they demonstrably are not! The proof is that they think they are. They should all take a long walk off a short pier. Thanks for your show. Never miss it.” From: Doug Resell, Branchville, Ontario.

“I found it quite perturbing to hear Dr. Donovan Kreutzer describe the clientele of his $3500 per year clinic as those who have fallen through the cracks of the medical system. Given the price tag, it seems reasonable to assume that only the most affluent members of Canadian society are able to access Dr Kreutzer’s services. Since a higher income bracket tends to correspond with better health and greater engagement in matters pertaining to personal health, it is fair to assume that the patients who frequent clinics like Provital are far from being the sickest or most needy members of Canadian society. While medicare is far from perfect, the principles of fairness and equity that are at the heart of the Canadian medical system are also at the heart of the Canadian identity. Clinics like Provital threaten these values, encouraging a two-tier system with inequitable access to important services. While Canadians certainly deserve the best healthcare possible, the exacerbation of systemic health inequalities between Canadians is not the way to bring about necessary change.” From: Alice Cavanagh, Toronto

“I can see why physicians would think its a good business idea: more money, maybe more time off and the ability to do better work. My problem is it will become the American system very quickly. I’m a 50 year old who needs a bypass and limited medical cover. I may have to refinance the house and arrange for my buisness or job to be taken care of. If there is a complication and that time goes over, I may have to take legal action or I lose everything I’ve worked for.” From: Rob Mowrey, Bowser, Saskatchewan.

“I would like to know how much of the concierge medicine you discussed is tax-deductible? I expect that some or all of the $3,500 annual individual fee is being “written off” from the taxes paid by the individual or their companies. Therefore, private front-of-the-line concierge medicine” is being subsidized by regular taxpayer who don’t get to join in the benefits.” From: Mark Richardson, Toronto.

Some of you wrote to us in support of concierge clinics.

“Great program on the emerging concierge style clinics. Both sides made good points. Doctors and clinics are inundated by the sheer weight of administration; taking doctors out of the system only makes the situation worse suggesting that some sort of middle way needs to be developed. I’m a user of this style of clinic. I have two major diagnoses including multiple sclerosis (MS). There’s no way I could get to a walk-in clinic, much less some clinic in the US. I’m not wealthy, but I’ve got no choice. I’ve got to have more and better access at the GP level. If the public system can provide me the same level of service, I’d be happy to go that route, since I probably won’t be able to afford the concierge clinic indefinitely. It’s ridiculous to suggest that if I want this level of service, I should go to the US to obtain it. These clinics aren’t only for the super-elite; the super-desperate and super-concerned require them as well. And I’m speaking as someone who has waited in a hallway for over 24 hours while a hospital bed is being found. I’ve waited 8 to 12 hours with full-blown MS symptoms in an emergency room, praying that I don’t throw up on the chair. If that’s your life, you’ll pay whatever you have to, to avoid those situations.” From: Kevin Cockle, Calgary.

“I’m very appreciative that you addressed this topic on your show. “Concierge” is not an appropriate label for an alternative delivery of medicine that is being chosen by both patients (rich or poor) and care providers alike. I find it pathetic that Canadians are being forced to put up with a system that repeatedly fails their health care needs. We all have numerous examples of failures. If the government does not allow choice then Canadians should sue the government for failing to provide adequate care given the extremely high cost each Canadian pays. This has occurred in Quebec and now private care is flourishing as it should while the public system fails. My father died prematurely due to separate diagnoses of melanoma that were not detected by the doctor. I refuse to allow my daughters to suffer myself, and neither should they.” From: Carol Ramer of Hartington

“I was very interested in your item about concierge medicine. I do not go to such a clinic; however, I can sympathize with those who do. Perhaps it is the need for continuity of care. We go to a Family Medicine Centre in Kingston and have done so for over 35 years. When we make an appointment to go there, we are always asked the purpose of the visit. There is always a new resident in training to look after us. We are asked why we are there, thereby making us feel like a new patient as well as wasting time. Maybe concierge medicine might afford the continuity of care that patients actually need, regrettably, for the money.” From: Carolyn Hudson, Kenora, Ontario

“I wonder about the ‘all or none’ idea with public health care. The policies for doctors seem to be either you’re in or you’re out. And then, the concern for the public is lack of access to quality specialists who have opted out. How about a model of care in which physicians choosing to offer fee-for-service be required to provide a certain percentage of their time to the public system, thus potentially making their expertise available within the public system as well. Would that be do-able?” From: Renee Land, Edmonton.

A number of health professionals also contributed their comments.

“As a family physician I think it’s fine that a private practice MD can prattle on about how bad is the public system, while they provide boutique care to maybe a couple hundred high-dollar patients. Are outcomes better? He didn’t say. What good is it to go to a diabetic’s home in the middle of the night when they’ll just go to the ER because the house call system that doctors can’t set up IV fluids, electrolyte monitoring, or insulin drips. Ditto for chest pain. If waiting ten hours in the ER sounds bad, I tell myself it’s better than waiting two to three weeks for a family doctor’s visit. The bottom line notes that these clinics provide an American-style option where you get care when you want it, versus when you need it. They also take publicly funded and trained doctors away from treating larger numbers of taxpayers. Doctors in the public system do a pretty good job, even if they don’t fit ideal, sometimes unrealistic patient expectations.” From: Jon Archibald MD, Peterborough, Ontario.

“I’m a registered nurse in Calgary and I work for the palliative home care program. I listened with interest to your show today, in particular to the thought that some people feel the system is not adequate, so they pay large amounts of money to have access to after-hours health care. Here in Calgary we have a Home Care Response Team. This team of registered nurses is available to home care patients and their families between the hours of four pm and eight am. For patients on the palliative team, they can phone in and speak to a registered nurse about issues such as pain control, symptoms such as nausea and vomiting, bleeding and end of life issues. We can try to help with some of the issues by phone; if necessary we will go out to the home. We have access to a palliative care physician and an after-hours pharmacy. So, if symptoms like pain or nausea are not well controlled, we can change the dose, change the drug, or change the route by which it is administered. We will go out to a home where someone dying and held the family emotional support or to help access the funeral home.”


March 11, 2011 |
Concierge Medicine Featured on
Canadian — Satellite Radio Program

Dr. Brian Goldman hosted an online radio interview on Friday, March 11, 2011 together with Live Right Now, Sirius Satellite Radio Channel 137 and CBC’s initiative to help Canadians live healthier. Dr. Goldman interviews one Canadian physician who is operating a successful concierge practice in Canada and has found a legal way to work and operate around The Canada Health Act.

These days, lots of people want priority access to everything from concerts to banking, and willing to pay for that privilege. Health care is no exception. “Concierge medicine” flourishes in the US, and it exists here too.

On this week’s show: how health care tries to lure the customer. You’ll hear from a doctor who got fed up providing “coach-class” medicine in the publicly funded system. Now he runs a practice where he always returns patients’ calls at night. And you’ll hear why some critics argue private clinics are a symptom of universal health care in trouble.


Medicare advocates call for Health Canada investigation into Copeman Healthcare Centre’s member-only “concierge medicine” model

By Lew MacDonald, Coordinator, BC Health Coalition

VANCOUVER, Feb. 1 /CNW/ – Concerned patient advocates, doctors and federal health critic MPs are calling on Ottawa to take action on the for-profit Copeman Healthcare Centre — a member-only primary care clinic based in Vancouver and Calgary.

Copeman charges an up-front access fee of $3,900 and ongoing fees of $2,900 per year that allow for preferred access to medical practitioners working there, the majority of whom bill the public health insurance plan for their services while only seeing patients who are members of the exclusive clinic.

The BC Health Coalition has received numerous complaints from members of the public who have been denied insured medical services because they are unable to pay the thousands of dollars in additional fees charged by the Copeman Centres.

“This is an issue of access to insured medical services on the basis of need,” said BCHC co-chair Rachel Tutte. “Health Canada must make it clear to provincial health ministries that charging access fees for membership in a primary care clinic violates the Canada Health Act requirement to provide
health services on uniform terms that do not impede access,” she said.

“Every time Copeman opens in a community it poaches family doctors and other professionals from that community, leaving patients who cannot afford its exorbitant fees without a family doctor,” said Dr. Nora Etches of Canadian Doctors for Medicare. “Charging large block fees and linking medically
unnecessary services to necessary ones undermines Medicare,” she added.

“The appearance of concierge medical clinics such as Copeman is troubling, because it will likely lead to the erosion of the overall quality of health care in this country, and privilege some Canadians over others based on ability to pay,” said federal NDP Health Critic Megan Leslie.

“Nobody in Canada should be able to charge patients for medically necessary procedures, whether routinely or on a priority basis,” said Liberal Health Critic Ujjal Dosanjh in a letter to federal Health Minister Leona Aglukkaq. “I ask that Health Canada investigate this clinic to determine whether it violates the principles of the Canada Health Act,” he added.

The calls come on the heels of a Quebec public health insurance board investigation into Medisys 123 and other concierge primary care clinics operating in that province, and follow last October’s promises by Health Canada to investigate Sentinelle Health Group in Ottawa.

“There have already been calls for Health Canada to take action on Sentinelle in Ottawa and Medisys 123 in Quebec — it’s time to add Copeman to that list,” said Tutte.

Why did Canadian premier Danny Williams
come to the United States for heart surgery?

Originally published in MedPage Today | By Michael Smith, MedPage Today | North American Correspondent

It is rare that a simple matter of patient choice causes an international flap.

But that’s what happened when 60-year-old Danny Williams of St. John’s, Newfoundland, decided to go to the U.S. for heart surgery.

That’s because Williams isn’t just any old Newfoundlander — he’s the premier of Canada’s easternmost province, the head of its government.

The disclosure Tuesday that Williams was in an undisclosed location in the U.S., having an undisclosed procedure that he couldn’t get in Newfoundland, brought catcalls from both sides of the border.

The New York Post, for instance, in an article headlined “Oh (no), Canada” used the news to take a whack at healthcare reform in the U.S. And the American Thinker blog — among many others — argued that Williams’ choice is evidence of the inferiority of Canada’s “technologically second-rate and rationed system.”

In Canada, cardiac specialists defended the premier’s decision as a matter of choice and at the same time noted that — with few exceptions — most cardiac procedures are both available and done well in Canada.

On the other hand, Newfoundland — with a population of about 500,000, less than Wyoming — is less well equipped. Doctors in the province do coronary artery bypass grafts (CABG) and other common procedures, but often send patients elsewhere in the country for transplants or rare operations.

By way of contrast, doctors in Ontario — Canada’s most populous province — handle more than 11,000 cardiac procedures a year in 11 specialized cardiac centers, according to Kori Kingsbury, CEO of Ontario’s Cardiac Care Network.

It’s one of the places a Newfoundland patient might go if appropriate care wasn’t available in that province, but Kingsbury said most of those 11,000-odd procedures are, in fact, performed on Ontario residents.

Still, a “handful” of Ontario patients go to the U.S. every year for surgery, usually because they need emergency treatment and live close to the border, she told MedPage Today.

And every year, a few Americans cross the border the other way seeking care, she said, although she did not immediately have exact numbers.

But for the most part, any required surgery can be obtained in a timely fashion in the province, Kingsbury said. In December, for instance, the median wait time for an elective isolated CABG was 14 days and urgent or emergency care was performed much more quickly.

The exceptions to that rule are rare, complex procedures the experts in which reside in the U.S., according to cardiac surgeon Chris Feindel, MD, of Toronto’s University Health Network.

But the only nonexperimental example he can think of is repair of a rare aneurysm in the descending aorta, where the best care for the procedure is at Baylor University in Texas, Feindel told reporters.

Because the condition is so rare, “there’s really no center across the country that has a large experience with these,” he told the Canadian Press.

In general, though, top-level cardiac care is readily available, according to Robert Roberts, MD, president of the University of Ottawa Heart Institute in the nation’s capital.

Roberts, who was head of cardiology at Baylor for 23 years before moving to Canada five years ago, said 99% of what can be done in the U.S. is done both routinely and well at his center.

Premier Williams’ decision may have been influenced by the knowledge that Newfoundland does not fare as well as the rest of the country in some cardiac outcomes.

According to the Canadian Institute for Health Information, the province has the highest rate of acute myocardial infarction, at 351 per 100,000 patients in 2007-2008.

More revealing is the unplanned hospital readmission rate after a heart attack, which is regarded as a measure of quality of care. In 2007-2008, 6.2% of Newfoundland patients were readmitted, significantly higher than the national rate of 5.2%.

And 30-day inhospital mortality — another marker of care quality — is also higher than the national average at 10.9% compared with 9.4%, the institute said.

Kathy Dunderdale, the province’s deputy premier, told reporters that Williams made the decision after weeks of consultation with his doctors and is expected make a full recovery.

But she would not comment on his location or what procedure he needed, saying only that he could not get the care he needed in the province.

A spokesman for the local health authority did not return telephone calls asking what procedures are not available in the province.

Dunderdale also did not comment on who will pay for the surgery. Usually, if it’s deemed medically necessary for a patient to travel outside the province for care, the taxpayer-funded medicare system picks up the tab.

But Williams — sometimes known as “Danny Millions” — is personally wealthy, having made a fortune in cable television.


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