As Alberta moves to implement its two-tier health care system with Bill 11, policymakers and commentators are increasingly debating whether Canadian provinces should pursue more private-pay medicine in response to the long wait times, and other challenges, that patients currently face. This is not the best way forward.
Alberta’s experiment with two-tier health care—access to surgery based on wealth, not need—will worsen wait times and undermine the principles of Canadian medicare.
And while our health care system is failing many Canadians, the solution is not to make it better for those who can pay while making it considerably worse for everyone else.
In Canada, access to health care is supposed to be based on need, not on ability to pay. Yet Alberta’s newly passed Bill 11, which takes effect on September 1, moves the province toward U.S.-style, for-profit health care.
For the first time in Canada, surgeons will be allowed to work in both the public system and a private-pay market for medically necessary surgeries. Before Bill 11, physicians could leave the public system and work privately, but they had to choose. Under Alberta’s new model, surgeons can participate in both systems simultaneously. Even Quebec, which has a more developed private sector, does not allow physicians to bill the public insurance plan while also charging other patients privately for the same medically necessary services.
This change will hurt the public health care system in many ways, but three concerns stand out:
First, Alberta already faces a shortage of nurses, anesthesiologists and other specialized staff. Many of the surgeries targeted for expansion—including hip and knee replacements, cataract surgery, hernia repairs, and endoscopic screening procedures—depend on these same professionals. Private facilities will compete with public hospitals for scarce personnel, drawing resources away from the public system.
Second, Alberta’s recent experience expanding for-profit surgical clinics is discouraging. Median wait times have increased for nine of the 11 major procedures being tracked, including all cancer surgeries. Greater reliance on for-profit surgical clinics has coincided with longer waits, including in emergency departments.
Third, the system creates perverse incentives. Surgeons and private facilities will be able to profit while faster access is available to those who can pay. There is no business model for private-pay surgeries if public wait times are short. During the Alberta government’s announcement, Health Minister Adriana LaGrange did not discourage physicians from making a “sales pitch” to patients seeking faster treatment. That is not a side effect of the policy. It is a predictable consequence.
Proponents point to Germany and Australia as models. But those comparisons are misleading. In many European countries, private practice is tightly regulated and most surgeons have hospital employment contracts that constrain private activity. Most also devote a larger share of spending to publicly funded care. Australia heavily subsidizes private insurance and has longer waits than Canada. Neither country demonstrates that two-tier care improves access for everyone.
Canadians should pay attention because the implications extend beyond Alberta. It is the first province to legislate two-tier health care while encouraging a private insurance market for medically necessary care. If this approach spreads, it could fundamentally change the character of Canadian Medicare and conflict with the Canada Health Act’s ban on financial barriers to care.
The issue comes down to a choice between two visions of health care—and two visions of Canada. One treats health care as a public good, where access is based on need. The other treats health care as a market, where investors profit from illness. Canadians should have an open discussion about health care. It should start with a simple question: do we want a system that rewards queue-jumping for the rich, or one that guarantees access based on need? Bill 11 moves Canada in the wrong direction.
About the authors
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.
Dr. Paul Parks
Dr. Paul Parks is an Alberta-based emergency room physician.
