Alberta has opened the door to a new health-care model allowing doctors to work in both private and public systems, but critics say it could contravene the Canada Health Act by giving faster access to those who can pay. The dual-practice model took effect Sept. 1. The province says doctors who choose to work in both systems must continue meeting their commitments to public patients. Critics argue the model could potentially create longer waits for people relying on the public system. Debate around the dual-practice model now centres on whether Alberta’s approach is compatible with the federal Canada Health Act. What changed Sept. 1? The changes, introduced through Bill 11, created a new category of physician known as a “flexibly participating physician,” who can provide insured services through Alberta’s public health plan while also providing privately paid services. The province says the goal is to increase capacity and give physicians more flexibility without reducing publicly funded care. Premier Danielle Smith says doctors have always had the ability to leave the public system and treat private patients. “It’s not illegal to opt out of the health system and treat private patients; we’ve seen that in Quebec,” she said Tuesday. “We wanted to make sure that doctors are able to continue providing us the service we need in the public system but then also take private patients.” The province also says nearly 400 physicians have expressed interest. “The main principle is that any doctor who wants to participate in dual practice has to continue providing us the same service that they currently do. They can’t reduce it,” Smith said. What critics say The Canada Health Act sets out conditions provinces must meet to receive full federal health transfers, including principles of universality and accessibility. Critics say allowing patients to pay privately for faster access could undermine those principles. Emma Phillips, a partner with Goldblatt Partners LLP who represents the Canadian Health Coalition, argues access to medically necessary care should not depend on a patient’s ability to pay. “It’s not in compliance with the Canada Health Act,” Phillips said. Phillips says the issue is not simply whether Albertans can still access care through the public system, but whether paying privately can move someone ahead of the public queue. “That is not universal access to health insurance. That is not universal access to health services,” Phillips said. She also argues private care could create financial barriers to timely treatment. “That is not reasonable access without financial barriers,” Phillips said. Safeguards promised In a statement provided on behalf of Health Minister Adriana LaGrange, press secretary Maddison McKee said dual practice does not violate the Canada Health Act and argued Alberta has the jurisdiction to determine how health care is delivered. “The act does not prohibit private practice outside the publicly insured system,” McKee said. The province says Albertans who choose to pay privately for eligible elective surgeries should be able to do so in Alberta, rather than travelling to other provinces. LaGrange’s office also says the province remains committed to ensuring Albertans do not have to pay out of pocket for medically necessary care. The province says the dual-practice model includes safeguards intended to prevent the private system from reducing publicly funded capacity. LaGrange’s office says those measures include limits on how physicians divide their time between public and private care, minimum public surgery-hour requirements, regular reviews and reporting on system performance and the ability to make further adjustments if needed. “This is why we proceeded through regulation rather than legislation—to ensure we can remain nimble and act as needed to add additional safeguards if required to protect the public system,” her office said. Concerns over care Dr. Jon Meddings, a retired gastroenterologist and former dean of the University of Calgary’s Cumming School of Medicine, says Alberta’s health-care system already has serious problems, but he doesn’t believe Bill 11 is the solution. “I’m not a fan or a proponent of our current system. I think our health-care system is in dire straits. People are waiting far too long for good care.” Meddings points to Alberta’s previous experience allowing people to pay privately for diagnostic imaging. “In the 1990s, Alberta was the first province to say, ‘Wait lists for imaging are a travesty. We can fix this, and we can fix this by having a private person pay for a scan, and that will free up a spot in the line for somebody who doesn’t pay,’” he said. “Thirty years later, we’re still doing it. The wait list has not changed.” He argues the new model creates a fundamental difference between patients who can pay and those who cannot. He disputes the argument private care will automatically shorten public wait times. He says that may happen when a patient leaves Alberta for treatment, but not if they stay in the province and use the same surgical resources. “They simply bought a position ahead of you, and your queue number actually moves backward.” Meddings and lawyers who have reviewed the legislation believe it contravenes the Canada Health Act. He also questions whether doctors will have an incentive to take on more private procedures, where they can potentially earn substantially more. “If you look at the surgeries that are being proposed under this—hips and knee arthroplasties being the major ones—already in the private sector, the cost in the chartered surgical facilities is anywhere up to four or five times what we pay in the public system,” he said. “So a physician is going to be left with the choice of: Do I get paid four or five times more for a case or not?” That, he argues, could have implications beyond patients waiting for hip or knee surgery. “When we pull resources in to do those—anesthetists, nursing staff—we deplete the workforce necessary to do car accidents, cancer surgery, heart surgery. And those are things no private facility will do,” he said. Patient paid $35,000 Mary Jane Faubert injured her knee while hiking in December 2023. The 63-year-old was diagnosed with a torn meniscus and eventually went through physiotherapy, imaging, specialist appointments, cortisone injections and other treatments. An orthopedic surgeon eventually confirmed she needed a knee replacement. After about two and a half years, Faubert recently received a call from Edmonton Bone and Joint telling her they would be able to perform the surgery. But she had already undergone the procedure privately in Ontario—at a cost of $35,000. “I got my life back, but it cost me to do it.” Faubert says the wait affected both her physical and mental health. She says she understands why some doctors may want to work privately but worries about what that means for patients who cannot afford it. “The people that can’t pay for it will also have to wait longer because now their orthopedic surgeon’s time is split between private and AHS,” she said. Faubert also questions how the province will monitor doctors’ commitments to the public system. She says she would recommend private treatment to someone who can afford it because, in her case, it allowed her to get her life back, but she says the ability to pay should not determine who receives timely care. “It’s unreal; it’s just a broken system.” What could be done? Both Meddings and Faubert say Alberta should focus on increasing capacity within the public system. Faubert says the province should hire more health-care workers and allow surgeons to perform more publicly funded operations. “If you don’t do that, the system’s going to stay broken,” she said. Meddings points to operating-room capacity as one area where Alberta could make changes. He estimates roughly one-third of operating rooms are sitting unused because of staffing and funding limitations. He says investing in the public system would be more effective. “If we have to pay more to staff the existing ORs, I would prefer to pay four times less than people were going to need to pay privately to staff those ORs publicly.” Ottawa watching changes The federal government has not publicly declared Alberta’s dual-practice model to be in violation of the Canada Health Act. Federal Health Minister Marjorie Michel has raised concerns about how the legislation will co-exist with the act’s principles of universality and accessibility. A spokesperson for Michel’s office said the federal government is discussing the issue with Alberta while respecting provincial jurisdiction. Smith says those discussions are ongoing, and Alberta wants an opportunity to demonstrate that the model can work. She says Alberta expects to have data within several months. Meanwhile, the Canada Health Act is also tied to federal health transfers. Provinces can face deductions from those payments for non-compliance, with the federal government reviewing provincial health plans each year. In March 2025, Alberta had $759,250 deducted over patient charges for medically necessary diagnostic services. Health Canada later issued a partial reimbursement of $5.7 million covering deductions from 2023, 2024 and 2025, citing Alberta’s efforts to improve access and eliminate those charges.
