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Less than one year after a private medical clinic opened in Calgary to angry protests, similar "members-only" facilities are spreading across Alberta.

Critics say the clinics are taking physicians away from the public system, making it even harder for those who can't afford thousands of dollars a year in membership fees to find a family doctor. But those running the clinics say they enable doctors to give their patients the care they deserve, while operating fully within Canada's medicare laws.

"It's obviously extra billing and queue jumping," said David Eggen, executive director of Friends of Medicare. "If this goes on unregulated, it'll spread like wildfire and we can see it, even in a recession, starting to expand here in Alberta."

Last September, protesters gathered as the Copeman Healthcare Centre opened in Calgary, saying they couldn't afford up to $3,900 a year in fees.

Several other clinics have since opened or are in the works, including Provital Health and Wellness, which is to open next month in Calgary. Former patients of the family doctors who will work at that clinic received a letter asking them to join. The letter suggests that "with a lower patient-to-doctor ratio our team is capable of spending the time to provide you with better care and concern." Attached is a fee schedule that puts cost for the first year at $3,500 and subsequent years at $3,000.

Copeman, which has another a clinic in Vancouver, has also said it will open an Edmonton clinic within months, Mr. Eggen said. Its website promises a Toronto location in 2009, with other provinces to follow.

Many people have concerns about the spread of these clinics, said Irfan Dhalla, a Toronto physician with Canadian Doctors for Medicare.

"First and foremost, charging patients fees for access to medically necessary services undermines the key principles of medicare," he said. "And if patients have to pay a fee to gain access to insured health services, then that's illegal."

It's already hard to find a family physician in Canada, he said, and doctors at these clinics will see fewer patients in a day. This model could make it even more difficult for people to find family doctors, he said.

An audit by the B.C. Medical Services Commission into the Copeman clinic cleared it of any allegations that its membership fees violate the Canada Health Act. Alberta Health Minister Ron Liepert has also said it appears the clinics fall within the guidelines.

Both Mr. Eggen and Dr. Dhalla said it's hard to track clinics that charge membership fees, since they don't have to register with the government and can quietly collect fees on the side. A report released last fall by the lobby group the Canadian Health Coalition said there were 16 "boutique physician clinics" across the country.

Gerard Boychuk, a political science professor at the University of Waterloo who wrote a recent report about Alberta and the Canada Health Act, said it would be difficult to prove that the clinics violate the act. The part of the law that refers to user fees is very specific, he said.

Alberta was penalized in the 1990s for charging the public system for individual, medically necessary procedures and then charging people fees on top of that. For the membership fee to fall under that umbrella, someone would have to prove that they refused to pay the membership fee and were therefore refused medically necessary treatment.

Still, the health act has traditionally been a political tool, Dr. Boychuk said. If private clinics grow increase and people start noticing an effect, the resulting political pressure on provincial and federal governments will likely have an impact. "That probably matters more than the letter of the Canada Health Act."

Mr. Eggen said his group will keep watching the clinics and will push the Alberta government to take a hard look at whether they're really helping public health care.

"The jury is still totally out on this - it's a matter of whether the government is willing to pursue it or not."