Several national health groups warn Alberta’s plan to let doctors work in both public and private health systems could worsen wait times. The Canadian Medical Association (CMA), Canadian Doctors for Medicare (CDM) and the Canadian Health Coalition (CHC) spoke out Thursday against the province’s move to allow “dual practice,” where physicians can bill the public system while also charging some patients privately. The change stems from Bill 11, the Health Statutes Amendment Act, which allows physicians to accept private payment for care that is otherwise publicly insured and publicly funded. Critics say the move risks creating a two-tier health system where those who can afford to pay receive faster care. “Doctors across Canada are deeply concerned about the Alberta government’s proposal to expand private health care,” said CMA president Dr. Margot Burnell. “This plan would take resources away from the public system and create a private option that only some people could afford. That would mean longer waits, fewer available doctors, and more strain on the public system, the one that most people depend upon.” The Alberta government has said the changes are meant to improve access to care, increase system capacity and shorten wait times. Alberta Premier Danielle Smith dismissed the concerns Thursday, saying the province’s priority remains protecting publicly funded care. “Well, they’re wrong,” Smith said, noting that Alberta’s approach would instead allow physicians to treat a limited number of private patients during times when they are not working within the public system. “Our priority is the public system, and we want to make sure that no one ever has to pay out of pocket for medically necessary care.” Smith notes the government will also monitor physician workloads to make sure doctors perform the same level of treatments and see the same number of patients they currently see in the public system. Critics warn of longer waits Dr. Danyaal Raza, a family physician and board director with CDM, said the legislation could fundamentally change how Canadians access care. “Medicare is not just a policy; medicare is a promise,” Raza said. “It’s a promise that in this country, when you are unwell, your care will come based on medical need and not on your ability to pay.” Raza said Bill 11 would allow physicians to charge patients directly for services that are currently covered under the public system. “In doing so, it creates for the first time since the Canada Health Act was passed a formal two-tier system in a Canadian province,” he said. He added that some physicians will naturally shift time towards patients paying out of pocket if they can earn more in a private market. “When physicians earn more in a private parallel system, this is where time, energy and expertise will disproportionately go,” he said. “Not for every doctor, but for enough that it will have meaningful consequences.” The CHC says Alberta’s move could also have ripple effects across the country, with the group’s chair Jason MacLean saying the group fears the legislation could set a precedent for other provinces. “Bill 11 is a direct threat to those achievements,” he said. “It violates the Canada Health Act’s requirements for public administration, accessibility and universality by allowing wealthier patients to jump queues and by enabling extra billing.” MacLean said the coalition has asked the federal health minister to use powers under the Canada Health Act to prevent the changes from taking effect. “If Ottawa allows Alberta to proceed, Bill 11 becomes a blueprint for others, and the damage spreads far beyond Alberta,” he said. Research points to workforce pressures University of Calgary professor and health economist Dr. Braden Manns said the province’s proposal is one of the most significant changes to Canada’s health-care system in decades. “This is probably the biggest change we’ve seen in health-care systems at an overarching level since the Canada Health Act was brought into being in 1984,” he said. Manns said dual practice would allow physicians to reserve some appointment slots for patients willing to pay privately. “They might wait between three months and 12 months to see me,” he said of patients in the public system. “But if you’re willing to pay me four times as much as the public system pays me, I’m going to save spots in that clinic to see people who can pay within one to four weeks.” He said the concern is that physicians and operating-room teams have limited resources. Manns, who co-authored a recent paper examining parallel private-pay systems and their impact on public care, cited evidence from jurisdictions such as Quebec and Manitoba where similar systems have been tested. His research shows that in Quebec, hundreds of doctors left the public system after rules around private billing changed, while wait times for publicly funded surgeries worsened. Meanwhile in Manitoba, a period of dual practice in the 1990s created stark differences in wait times depending on whether patients paid privately. A 2005 study cited Manns’ research found patients who paid for private cataract surgery waited about four weeks. Those relying on the public system waited roughly 10 weeks if their doctor worked only in the public sector, and 23 weeks if their surgeon split time between public and private work. The study also found Canada already has fewer physicians than many countries that allow parallel private systems. Without increasing the number of health professionals, the authors argue, introducing private-pay care could divert scarce staff away from public hospitals and lengthen wait times. Still, Smith refutes those claims. “I think what we’ve observed in Quebec is that because Quebec has made their doctors make a choice of whether to be in public or private (health care), they’re seeing an increasing number of doctors go into the private system and not be available at all to do public surgeries and public treatment, she said. Smith added some private care could also increase overall capacity and reduce wait lists. “We anticipate this will increase capacity,” Smith said. “We also anticipate that there are a certain number of Albertans that will take themselves off the public queue in order to take advantage of that option.” The legislation enabling the changes is expected to move forward during the current legislative session.
