As premiers and the prime minister gathered in Charlottetown from July 21-23 to discuss public health care at the Council of the Federation, the Alberta government was quietly working to further its two-tier system.

On July 22, the Alberta government approved three Orders in Council that shed light on how the provincial government is building a private health insurance market and undermining equal access to health care services.

The three Orders in Council relate to the implementation of Bill 29 which the legislative assembly introduced in April 2026 as the legal framework for two-tier diagnostic testing without requiring a practitioner’s referral. 

This legislation formalizes queue-jumping for those who can pay out of pocket or with private insurance for self-referred testing in order to jump to the front of the line for treatment. It is also a move designed to feed the for-profit health care industry and create a market for private health insurance products.

The first Order in Council brings key provisions of Bill 29—the two-tier diagnostic testing legislation—into force effective July 31. 

The second amends the Alberta Health Care Insurance Regulation by creating a new category of “preventative health testing services” which are “not insured services” under the Alberta Health Care Insurance Act and to make it appear that the Alberta government is maintaining compliance with the Canada Health Act, even though it is not. The amendment also establishes that “all preventative health testing services…are extended health services” under a forthcoming Preventative Health Testing Services Benefit Regulation.

The third regulation maintains that certain procedures involved in providing these “preventative health testing services” remain restricted activities that must only be performed by authorized regulated health professionals. These include administering anesthetic gases for the purposes of anesthesia or sedation, radiopharmaceuticals, and diagnostic imaging contrast agents, and ionizing radiation (such as, x-rays).

In a press conference on July 27, the Alberta government announced that CT, MRI, ultrasound, x-ray, and CT services will initially be under the banner of these “preventative health testing services.” If cancer is found through these “preventative” scans, the government will reimburse for the private cost.  At the press conference, a radiologist spokesperson also revealed that the Alberta government has been already allowing private-pay medical imaging tests (that number in the “low tens of thousands” annually), which suggests that the Alberta government has already been in violation of the Canada Health Act.

What does it all mean?

These legislative amendments are part and parcel of establishing Alberta’s two-tier health care system with a private health insurance market for medically necessary health care services that are already covered under the public plan. 

The Alberta government is moving quickly to build a two-tier system

The Alberta government is working towards a September 2026 deadline to have its two-tier system up and running. In order to build this market, the Alberta government must give legal certainty to investors, for-profit facilities, insurance corporations, and physicians and health professionals intending to work in the private-pay tier. 

The implementation of private-pay diagnostic testing is part of the government’s overall plan for a two-tier system that will allow physicians and surgeons to work simultaneously in the private-pay market as well as the public system (referred to as “dual practice” under Bill 11).

A two-tier system requires private-pay diagnostic testing

The legislation and regulations are written in an open-ended manner to include any form of diagnostic testing, ranging from lab testing, medical imaging and any other diagnostic procedures performed in any health care settings. To start, the Alberta government is beginning with the most common medical imaging procedures.

A two-tier system demands that private-pay diagnostic testing be in place to enable queue-jumping. Individuals must generally have some form of diagnostic testing completed before jumping the queue for surgery or medical procedures.

Under the guise of “preventative health testing services,” these legislative amendments are intended to give legal cover to entities engaged in delivering or financing private-pay health care that provides preferential access, contrary to the Canada Health Act. 

The Alberta government is creating a new category of diagnostic testing that will expressly facilitate faster access based on ability to pay. If there are concerns identified from the “preventative” diagnostic testing, then those individuals will be able to jump to the front of the line for treatment. These practices are prohibited under the Canada Health Act, but the Alberta government wants to create new definitions to provide legal certainty provincially for private interests engaged in these unlawful activities.

For-profit interests have been using the language of “preventative” health services in order to blur the boundaries between medically necessary (publicly insured) services and uninsured services that are not medically required. Corporate interests increasingly use the language of  “preventative” health services in claiming that these services do not constitute unlawful patient fees and are therefore not against the Canada Health Act, even when these practices provide faster access to medically necessary care. 

In B.C., the provincial government sought a court injunction against Telus Health for a subscription-based health care program. In its petition filed in B.C. Supreme Court, the Medical Services Commission “investigated and determined that Telus Health is charging for or in relation to MSP covered medical services such that a reasonable person would consider that the purchase of Telus Health’s services would result in preferential treatment or priority access to those services.” Telus Health argued that “we do not charge for primary care services with our LifePlus service. Our fee is [for] preventative health uninsured services like dietitians, kinesiologists and wellness services.” 

However, the B.C. Medical Services Commission hired a private investigator to pose as a potential patient in order to determine if private payment was required to obtain medically necessary primary care covered under the public plan. This investigation revealed that in order to access a family physician one would need to pay the annual membership fee. 

The B.C. Medical Services Commission was also able to determine that the movement of family physicians into the private-pay tier reduced access to family medicine services within the publicly funded system. This finding challenges the longstanding argument that private-pay health care increases health care system capacity. Instead, the physician workforce shifts to the more lucrative private-pay market.

Telus Health and the B.C. government settled the dispute out of court with Telus voluntarily changing its program in order to come into compliance with provincial legislation banning preferential access to medically necessary health care.

Private-pay diagnostic testing could be a large segment of the new private health insurance market

The focus on private-pay diagnostic testing will be used by the Alberta government and the insurance industry to build the private health insurance market. Medical imaging, in particular, is already a burgeoning for-profit industry, with private facilities accepting both public and private payment. Telus Health has already been advertising $3,000 “total body MRIs”, which are not clinically recommended.

By using the language of “preventative health testing,” the Alberta government is creating the legal certainty for insurance corporations to sell products for “preventative” extended health services, even though these very diagnostic tests will be used as the main vehicle for preferential access to treatment.

Undermining primary health care and adding unnecessary testing

The Alberta government is opportunistically preying on Albertans’ valid concerns over long wait times by sanctioning private-pay diagnostic testing, which will ensure faster access for patients without a primary care provider or specialist. The move to self-referral for diagnostic testing undermines the foundational role of primary health care as the necessary front door to the health care system where primary care providers refer to medically necessary diagnostic testing. 

Even without self-referral for diagnostic testing, a 2017 report from Choosing Wisely Canada and the Canadian Institute for Health Information concluded that up to 30 per cent of imaging tests, procedures, and pharmaceutical therapies across eight priority areas are potentially unnecessary. Encouraging the growth of “preventative health testing services” through self-referral and private payment will dramatically increase unnecessary testing and draw limited health professionals out of the public system. 

Diagnostic testing and access to (cancer) treatment will depend on wealth

Even before Bill 11, Bill 29, and the introduction of an express diagnostic testing line, Alberta’s experiment with greater publicly funded, for-profit health care delivery resulted in longer public waits for nine out of 11 priority procedures, including all cancer surgeries tracked by the Canadian Institute for Health Information. 

The international evidence is clear. The movement of a limited pool of health care professionals, including medical imaging technologists and radiologists, into the private-pay market will increase wait times in the public system. Under these changes, access to diagnostic testing and medically necessary care—including cancer treatment—will depend on your wealth. 

Albertans who can afford expensive private health insurance premiums or pay thousands of dollars out of pocket, will receive their treatment faster. This is U.S.-style, two-tier health care plain and simple—and this recent move is about guaranteeing a market for private insurance companies and for-profit providers.

About the author

Andrew Longhurst

Andrew Longhurst is a senior researcher and political economist, with a focus on health policy, at the Canadian Centre for Policy Alternatives. His work has been published in academic journals and by research institutes, including Canadian Journal on Aging, Political Geography, the CCPA, and the Parkland Institute.