Edmonton (Rajeev Sharma): Alberta’s recently enacted Bill 11 could fundamentally alter the province’s public health-care system and pave the way for a two-tier model similar to that of the United States, according to a new report released by the Canadian Centre for Policy Alternatives (CCPA) and the Parkland Institute.
The Health Statutes Amendment Act, 2025 (No. 2), known as Bill 11, came into force on Dec. 18 and allows physicians to practise in both the public and private health-care systems under a “dual practice” model. The Alberta government has said the move is intended to ease pressure on the public system and reduce wait times.
However, the report — The end of Canadian medicare? Alberta legislation opens the door to U.S. health care — argues the legislation is unprecedented in Canada and risks undermining the single-payer nature of public health care.
“This is unlike what exists in any other part of the country. It’s a first in Canada,” said Andrew Longhurst, senior researcher with the CCPA and co-author of the report, alongside Parkland Institute research manager Rebecca Graff-McRae. Longhurst said the changes could have significant consequences not only for Alberta, but for the rest of the country as well.
According to the report, Bill 11 could funnel physicians, nurses and anesthesiologists toward private facilities such as chartered surgical facilities (CSFs), effectively creating faster access for patients who can afford to pay privately, while extending wait times in the public system. Alberta Health Minister Matt Jones previously said about 20 per cent of surgeries in the province are already performed in CSFs.
The authors define two-tier health care as a system in which patients with the ability to pay can bypass public queues, leaving others to face longer delays. Longhurst said the legislation may violate several provisions of the Canada Health Act, potentially putting federal health transfers to Alberta at risk.
In response, Health Canada said the federal government remains committed to protecting the Canada Health Act and universal health care. A spokesperson for federal Health Minister Marjorie Michel said officials are working with Alberta to better understand the implications of the changes and that discussions between federal and provincial counterparts are ongoing.
The Alberta government has pushed back against the report’s conclusions. Ministry spokesperson Maddison McKee dismissed it as politically motivated, saying the province remains committed to a strong publicly funded health system and ensuring Albertans do not pay out of pocket for medically necessary care.
Some experts argue a dual practice model can work if implemented carefully. The Alberta government has pointed to countries such as Denmark, the United Kingdom and Australia, where variations of dual systems exist. Economist Emmanuelle Faubert of the Montreal Economic Institute said such models can offer benefits, including shorter wait times and more time with physicians, provided strong safeguards are in place.
Longhurst, however, cautioned against comparisons with European systems, noting those countries often have significantly higher numbers of physicians per capita than Canada. He warned that workforce shortages could make a two-tier system unworkable and exacerbate existing gaps in care.
The report also raises concerns that Alberta’s approach could encourage other provinces to follow suit, potentially weakening Canada’s public health-care system nationwide.
