The Regulatory Questions Behind Alberta’s Health Reform
The debate surrounding public and private health care in Alberta has resurfaced following the passage of Bill 11: Health Statutes Amendment Act, 2025. The government introduced the bill with the stated goal of increasing access to health services by permitting physicians to establish dual practices—working within the publicly funded system while also offering fee-based services outside it.
The government argues that this flexibility will expand patient choice and improve system performance. Anticipated benefits include longer physician working hours, more efficient use of health care infrastructure, and improved physician recruitment and retention. However, evidence supporting these anticipated outcomes has not yet been clearly articulated. Government members note that dual practice models exist in many Western countries with high-performing health systems, while critics caution that the policy could lead to a two-tiered system similar to that of the United States.
The precise structure of Alberta’s model remains uncertain, as regulations governing private practice under the legislation have not yet been released. While several comparable countries—including Norway, Germany, and Australia—permit forms of dual practice, they also implement significant safeguards. In many European systems, physicians are salaried employees rather than independent practitioners, and their public/private balance is governed by contractual requirements. These often include minimum public service obligations, revenue-sharing arrangements for use of public facilities, scheduling controls, disclosure requirements, and meaningful penalties for non-compliance. Additionally, most European countries finance a greater share of healthcare costs than Alberta, and include a wider range of services such as dental care and prescription drugs, which affect overall health.
Bill 11 includes relatively few of these guardrails. The primary requirement is that physicians offering private services must provide written information regarding costs, payment requirements, and the availability of services within the publicly funded system. It remains unclear whether additional oversight mechanisms will be introduced through regulation.
Evidence from other jurisdictions offers mixed conclusions. Some studies suggest that physicians engaged in dual practice may increase their total working hours. However, additional private hours can correspond with reduced public system availability. While overall procedure volumes may increase, this may result in shorter waits for privately paying patients without improving wait times in the public system. Australia’s experience with increased privatization did not result in reduced wait times, and current wait times for procedures such as cataract surgery, coronary bypass surgery, and hip and knee replacement exceed those in Canada.
In Saskatchewan, wait times were successfully reduced, but research indicates that improvements were largely attributable to system-level reforms rather than expanded fee-based practice. These initiatives included the development of an online specialist directory, pooled referral systems, increased funding for operating room staffing, falls prevention programs, and the implementation of a streamlined single-entry referral pathway.
As implementation of the Health Statutes Amendment Act, 2025 proceeds, the details of its regulatory framework will be critical. Key questions remain:
Will minimum public service requirements be established?
Will private services be delivered in currently underutilized facilities, or will new competing surgical centres be developed?
Will physicians using public facilities for private services be subject to revenue-sharing arrangements?
Will the government introduce pooled referrals and a single-entry system?
Will additional operating room time and staffing be funded to optimize existing infrastructure?
The long-term impact of Bill 11 will depend less on its stated intentions and more on how these details are addressed.
If you would like to discuss your perspectives and concerns about the future of Alberta’s health care system, our team would welcome the opportunity to meet with you.