BC clinic brings executive care
to the masses

Fees buy longer visits, shorter waits. NDP cries foul but Grits say it's legit

By Peter Woodford

"Anyone who thinks we don't have two-tiered medicine ought to take a closer look at the system," says Kyle Kotapski, co-director of Options Health System (OHS), a new private health clinic in Victoria, BC. The facility, which Mr Kotapski started with chiropractor Jamie Grimes, opened November 1st and has been roundly criticized for undermining medicare by charging its members an annual fee in exchange for a range of 'executive' style health services. "Executive care has been around for years but when we do something like this and bring it to the street and offer it to the average person who wants to be proactive about their health — we get vilified," says Mr Kotapski. OHS claims to be the first clinic in Canada to bring affordable 'executive care' to average Canadians. Mr Kotapski adds that OHS's fee-based mix of GP services with complementary and alternative medicine is, to his knowledge, unique in Canada. They're planning to open two more clinics, in Comox and Nanaimo, by next summer.

IN A NUTSHELL
Service fees cost $300 a month for the first year and $200 a month each subsequent year. "It works in the exact same way as it would in the public system; you book your appointment, you see your GP then you come in and have an appointment just as you normally would," explains Mr Kotapski. "The difference is that patients get a minimum half-hour each visit and there are no limits to how many key complaints they can have per visit, they get guaranteed same-day appointment times. We're just packaging resources that are already currently available privately and offering them at a discounted rate," he adds. "But it's not a spa fee clients can't just show up and get a massage every day."

EXECUTIVE CARE LITE
While the clinic is also courting business clients, its approach differs from established executive health firms which deal almost exclusively with corporations. These companies tend to emphasize preventative care for their well-heeled clients. Their big selling point is the executive physical, which offers a whole gamut of (expensive) tests. If an illness is detected clients are usually referred to a doctor in the public system or sent to a US facility. Clients are able to jump queues for procedures thanks to a loophole in the Canada Health Act for "third party payers" that was originally intended for military, RCMP and provincial workers' compensation boards.

Montreal-based Medisys is the largest of these companies. Its CEO Dr Sheldon Elman is former Prime Minister Paul Martin's personal physician. With five executive wellness centres coast-to-coast and 19 medical imaging clinics, its annual sales are estimated to exceed $50 million. But unlike OHS, it doesn't market to individuals, but operates mainly through big insurance companies like Sun Life.

CORRIDOR COLLABORATION
So far OHS has been a rousing success. There's already a two week waiting list for clients who'd like to enrol and the company is already hiring more physicians. OHS currently has a nine practitioner team, of whom only two are MDs. The others offer services like chiropractic, naturopathy, nutritional counselling and athletic therapy. The "system" in the company's name refers to the philosophy of these different practitioners working together in what they call "corridor collaboration."

Though he hints that doctors who are sceptical about naturopaths and their ilk might not feel at home at OHS, Mr Kotapski says the two physicians currently working for the clinic are very pleased with the clinic's setup — mostly because it allows them to see each patient for 30 minutes. "I think that a lot of doctors would like to practise like this but the public system isn't able to properly compensate doctors for that amount of time," he says. He strongly implies OHS pays better than the BC government, but declines to name the exact fees. "All doctors get into this for the same reason: to provide the highest quality of care for their patients. But after a while the business realities of medicine force you to see 30 or 40 patients a day, through no fault of your own." He adds that in the current public system, physiotherapists and chiropractors often have greater earning potential than their GP colleagues. "It just doesn't seem right or fair."

Even though OHS's two GP staffers have continued to work shifts in the public system, their services at the clinic are strictly for paying customers. "We pay them to consult for us," he says. "What we actually compensate our GPs and everybody else for is not the primary service it's the additional time and resources that are brought to bear to put together a health and wellness profile, to follow up consistently, and to do exams that just aren't covered by the public system."

CANADA HEALTH CRIME?
That's exactly what bothers people like Carole James, leader of the BC New Democrats. She's publicly attacked OHS, suggesting the clinic is violating the Canada Health Act. "Every one of these clinics that opens, that has an additional cost for patients to join and get access to see a doctor, crosses a line," she told the Times-Colonist. "It's a two-tier system."

But BC's Liberal health minister George Abbott says that's poppycock. "I think it's foolish to think that it in any way represents a threat to the public healthcare system," he told the same paper. For its part, OHS isn't taking any chances. The clinic recently ran an ad in BC-based magazine Business Edge pledging "Quality health care delivered quickly while upholding Canada Health Act."