On April 13, the Alberta government introduced legislation to become the first province that creates a “me first” legal framework for patients to pay privately for diagnostic testing without even needing a doctor’s referral—a move designed to feed the private health care system.
And it might be eligible for reimbursement by the Alberta government.
What are these newly defined “preventative health testing services” in Alberta’s new legislation? It’s hard to know because the bill provides little clarity.
As Bill 29 (the Medical Statutes Amendment Act, 2026) states, “preventative health testing services” means goods and services or classes of goods and services that are (i) provided by a practitioner, (ii) made available through a self-referral, and (iii) specified by the Minister by order as preventative health testing services.”
Clear as mud.
The Alberta health minister responsible for the legislation also doesn’t seem to have specifics. In the press conference, when asked by multiple journalists which diagnostic tests the government has in mind, the message was that all will be clarified in the yet-to-be-developed regulations by the fall.
When asked how the public system can respond to increased demand for private-pay diagnostic testing, the the Minister of Primary and Preventative Health Services responded that the private market will meet the new demand: “The capacity is that if there is demand, paying for these tests themselves, there will be a private market that will step in to meet that demand. It would be in addition to what we currently have.”
Two-tier testing means the wealthiest get their diagnosis and treatment first
What is clear about Bill 29 is that it creates a legal framework that encourages for-profit medical imaging facilities to charge wealthy patients privately for diagnostic testing—and receive a diagnosis—before everyone else on the public wait list.
These tests—which may include medical imaging modalities (MRI, CT scans, etc.)—are likely to be performed and interpreted by radiologists and the limited pool of technologists who are working in the private-pay and publicly funded system simultaneously.
Remember that in December, Alberta opened the privatization door through Bill 11 by introducing legislation that allows doctors and surgeons to work in the public and private systems at the same time, no longer having to decide which system they will work in.
Bill 11 also establishes the provincial public insurance plan as the “payer of last resort.” This means that if individuals have other private health insurance that covers medically necessary health services—as Bill 11 does—it creates a large market for private health insurers in what would previously be considered publicly funded services. It’s a boon for private health insurance companies and helps to rapidly increase the private market that the health minister alluded to. Those with access to private health insurance—those who are able to pay thousands of dollars in premiums or able to pay out of pocket—will get their diagnosis and treatment sooner if they receive their diagnostic testing faster.
The Alberta government will reduce the supply of diagnostics for those with urgent need
Bill 29 must be understood in relation to Alberta’s previous Bill 11, which paved the way for physicians and surgeons to work in the public system and private-pay market at the same time. The intent of Bill 29 is to build a burgeoning for-profit diagnostic imaging industry that has access to both private payment—through private insurance or out-of-pocket payments—and the benefit of public funding to make it viable.
Empirical research shows that increasing private payment for medical imaging and other diagnostic testing will encourage those providers to focus their time in the more lucrative private-pay market. This is what we see with privately financed health care generally. And to add insult to injury, we are already facing shortages of medical imaging technologists in Canada.
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. We can assume that self-referral will contribute to a large amount of unnecessary testing that takes resources away from those who have an urgent referral by a medical provider.
Technological advances have contributed to the growth of diagnostic imaging (e.g., x-ray, MRI, CT). In many cases, diagnostic medical imaging is necessary for diagnosis. However, growing evidence suggests that many imaging tests are not necessary and may create unnecessary and avoidable patient harm. A 2009 U.S. study estimated that 15,000 Americans will die each year from exposure to radiation if current levels of CT scanning continue. Based on a review of eight Canadian studies, the share of inappropriate MRI exams was estimated to range from two to 28.5 per cent (in large measure because methodologies in these studied varied).
Private-pay diagnostic testing contravenes the Canada Health Act
Researchers and clinicians have long called for provinces and the federal government to address the issue of unnecessary and potentially harmful diagnostic testing and procedures. Rather than move in this evidence-based direction, the Alberta government is doubling down on building a two-tier health care system that will benefit private health insurance companies and for-profit providers—and Alberta’s wealthiest.
Inequitable access to diagnostic imaging became such a problem that the federal government issued the Diagnostic Services Policy in 2019, which clarified that access to medically necessary medical imaging must be based on need and not ability or willingness to pay. The federal government recognized that a two-tier system for diagnostic testing would give some faster access to diagnosis and treatment and leave others waiting much longer. The Alberta government has already lost an estimated $13 million in federal funding due to unlawful patient charges and extra-billing in 2023 and 2024.
But once again, the Alberta government is pursuing legislative reforms that are fundamentally at odds with the Canada Health Act. Private-pay testing will increase public wait times, making the diagnostic testing bottleneck worse, and continue to unravel the foundational principles of the Canada Health Act. It also embeds income and wealth inequality into the health care system—something Medicare was designed to prevent.
