Premier Danielle Smith and Matt Jones, minister of hospitals, make a health-care announcement in Calgary on Nov. 14.--CP Photo Jeff McIntosh
zmason@medicinehatnews.com
A draft legislation obtained by the Globe & Mail dated Nov. 5 suggests the province intends to allow physicians to work concurrently in both a public and private health system.
The Globe reported that the draft legislation would allow participating physicians to determine which services they provide privately on a “case-by-case basis.” Physicians would not be required to disclose to the government which services they intend to privatize in which system.
While several Canadian provinces, Alberta included, currently offer certain private services alongside the public health-care system, none allow doctors to work in both systems simultaneously.
Public health advocates in Alberta and across the country are raising alarms in response to the leaked legislation, which they say represents a troubling slide toward a fully two-tiered health-care system.
“Whenever somebody says creating this second stream is all about access and choice, the immediate response always has to be: access for whom? Choice for whom?” said Rebecca Graff-McRae, research manager at the University of Alberta’s Parkland Institute.
“It will be access for those either willing to pay, or desperate enough to have to pay.”
Canadian Doctors for Medicare, a nationwide advocacy group, released a statement Wednesday warning the plan outlined in the draft threatens to undermine public health care and is urging the UCP government to reconsider.
“This will quickly create a two-tiered system that expedites care for those who pay privately, while increasing wait times for people who can’t afford to pay,” said Dr. Thara Kumar, a former board director of Canadian Doctors for Medicare and an emergency physician in Red Deer.
The group says there is no convincing evidence that private-pay health care reduces overall wait times. Australia and the United Kingdom saw unchanged or increased wait times after introducing parallel private-pay.
“We remain committed to upholding Alberta’s Public Health Care Guarantee, ensuring that under no circumstances will any Albertan ever have to pay out-of-pocket to see their family doctor or to get the medical treatment they need,” reads a statement from Maddison McKee, a spokeswoman for Minister Adriana LaGrange, whose office is responsible for the draft.
“The crucial phrase is ‘have to’ pay,” says Chris Gallaway, executive director of Friends of Medicare. “But they’re creating a scenario where those who have money will get to pay to skip the queue. They’re not making it that you have to pay to access care, but will there be health care there for you if you don’t pay?”
“I think the very first thing we have to acknowledge is the reality of math. We only have one workforce,” said Graff-McRae.
“It’s like the supermarket. You’re creating two checkouts that are open, but you only have one cashier. If your cashier has to keep moving back and forth between two checkout lines, do the lines get shorter?”
Data from the Parkland Institute suggests the province’s already years-long effort to expand privatization has had counterproductive effects, including increasing wait times for complex procedures like cancer surgeries and increasing spending on outsourced procedures.
McKee described the Parkland Institute as “the NDP’s unofficial research arm” in a statement to the News.
“Their work is completely biased and lacking credibility, including an ongoing campaign of false claims about ASI specifically, and it is misleading to cite them as if they were impartial or a legitimate research organization.”
The Alberta Surgical Initiative was introduced in 2019 to expand access to surgeries in private clinics. But the province’s own data suggests increased investment in private health services has had the effect of undermining the public system.
According to the province’s most recent Annual Health Report, 318,601 surgeries were provided in 2024-25, the most in Alberta’s history. Of those, 20.2 per cent were performed in chartered surgical facilities, for approximately 64,500.
That leaves the remaining procedures, totalling 254,101, performed in the public system. It’s a notable drop when compared to the 256,656 procedures performed in the public system in 2018-19, prior to the introduction of ASI, according to data from previous annual reports.
Not only has the public system provided more than 2,500 fewer surgeries this year, but advocates say the surgeries picked up by CSFs in the meantime are overwhelmingly straightforward procedures for non-life threatening conditions, like orthopaedic surgeries and cataract procedures.
“They’re creating profit motives that prioritize certain types of care in certain places, and so that means the rest of the care isn’t being prioritized,” said Gallaway. “Of course, it’s going to be more profitable to take on patients who are less complex, need less care. They’re going to get prioritized. If you have a serious condition, you’re probably going to be left waiting even longer.”
“It’s very clear that the government’s priority on this is volume, and volume of particular procedures. They want something that looks like a win for speed and efficiency and getting people off the waitlist. But I think that’s really quite misleading,” said Graff-McRae.
Gallaway also says the manner in which the information reached the public is cause for concern.
“This government and the premier in the last election ran on a public health guarantee. They did not run on any of the things they’ve been doing since then. None of this was in their platform. None of this was discussed with the public.”
“Often we learn about these things from a leak to the media or from the opposition or elsewhere,” he said. “They’re not being transparent, they’re not consulting Albertans. They’re cooking it up in the dark, and then we find out about it by accident. That is not how a democratic government should work.”
Graff-McRae says it’s important for Albertans to understand the dual-track proposal in the context of the other changes impacting health-care delivery in the province.
“We see the headline, we see the announcement, and we think ‘at least somebody’s doing something,'” she said.
“It is the opposite of doing something. It’s worse than doing nothing. It’s actively a process of undermining the public system in favour of creating this new stream.”
