Dual health-care system could create ‘negative competition’: professor

Lorian Hardcastle on Alberta Primetime Nov 26, 2025

Lorian Hardcastle with the University of Calgary’s Faculty of Law and Cumming School of Medicine joins Alberta Primetime host Michael Higgins to discuss the UCP government’s plans to add private health care options in Alberta.

This interview has been edited for clarity and length.

Michael Higgins: How much of a fix is this for the frustrations many Albertans have with the health-care system?

Lorian Hardcastle: I don’t think it’s a fix for the overall system. It may be for the person who is able to buy services and there is a physician willing to provide them. That person may feel happy with these changes, but for the overall system it really isn’t going to be a fix.

We can look at other places that have tried this. The issue is that you have a finite pool of doctors and they have some private patients, some public patients. Those private patients may get seen faster. The public patients, who are on average going to be less healthy with more complex medical needs, may end up waiting longer. Their conditions deteriorating as a result.

MH: How prepared is the Alberta government to move this forward, and do it successfully?

LH: I don’t think they’re prepared. A lot of the legislation leaves the safeguards that will be in place up to ministerial order. There’s not a lot in the legislation to try to preserve the public system. It seems we’re just going to forge ahead.

What I would have liked to see instead is us looking at other jurisdictions that do this, some of the safeguards they have in place to make sure doctors are spending enough time in the public system, treating public patients, and considering what we might borrow from those places. But there isn’t a lot of evidence the government is planning on doing a lot in terms of those safeguards at this point.

MH: How complex or convoluted could this system end up being to navigate for patients?

LH: It could be quite complex. From a patient perspective, you may end up having difficult interactions with your doctor, where maybe they’re offering you service quicker if you pay. You may not know, should I pay? Should I not pay? Adding that kind of conflict of interest in that relationship. Then if you can’t pay, how do you find another doctor who could see you quicker without paying, and how do you navigate all of that?

Then, from a physician perspective this will add complexity potentially to their lives as well. If they opt in instead of just seeing patients and billing the government, they will be seeing patients, billing the government, billing patients privately, collecting on those on those bills, potentially billing private insurers. There could be a lot of administrative complexity.

Then also for the government. If the government is going to put limits on what doctors can do and how they can do it, they’re going to have to also put time and money into enforcing those rules. So a lot of complexity is coming down the pike.

MH: How competitive a dynamic do you see evolving between private and public health care?

LH: When we think of competition, sometimes it’s used in a good way. Competition breeds innovation or price competition. But I think the kind of competition we’re going to see here is negative competition in that you have this finite pool of health professionals with a finite amount of time. If they’re being pulled into the private system because it’s more lucrative, because the patients have less complex medical needs, then you’ll have competition between those who can pay and those who can’t.

MH: How do you see this policy shift hitting the radar where the Canada Health Act is concerned?

LH: If you read the legislation, there are some parts where the Alberta government clearly tried to address the Canada Health Act. For example, doctors can’t both bill the public system and charge patients on top of that, which is a clear prohibition in the Canada Health Act. But the Canada Health Act also more generally protects accessibility. Accessibility is defined as being able to access insured services without financial barriers.

We don’t know how this is going to play out yet, but potentially we could end up in a situation where people are facing financial barriers to care. Either pay or wait. I could see the federal government certainly getting engaged, potentially even withholding money from Alberta, depending how this plays out.

MH: How much of a path does this pave toward an American-style health-care system?

Does is open a door to health corporations moving into the province?

LH: Potentially. Certainly the government under Premier Kenney already cracked the door a little bit by allowing for private delivery of health services in a way that the government is paying, but those who are delivering them are potentially private corporations who can then bill a government. The door was already cracked.

This opens the crack further, because there’s a lot of discussion about people paying out of pocket. I wonder if a private insurance industry isn’t going to evolve, and then I think we are likely to see some of the problems from the U.S. We’re likely to see health equity - the gap between the healthy and the sick - who are also often the wealthy and the not. That gap is likely to increase, and then we’re also going to see administrative costs go up. The U.S. spends tremendous amount of money on administering their system. So I think we will see some of those American problems start to turn up in Canada.

MH: Is the likelihood Albertans will need to invest in health insurance the way Americans do on the horizon?

LH: We may see a market for private insurance evolve in the in the province. Right now, the only private insurance is really for services outside of the public system, like dental and drugs. We could potentially see an insurance market emerge for some of those medically necessary services within the public system that currently there isn’t a market for.

It’ll be interesting to see how some of those big health insurers that exist in Canada already, but that also exist outside of Canada, may respond to these changes.