The province of Alberta is preparing for one of the most radical changes in the healthcare system in decades. According to a draft bill first reported by The Globe and Mail, the Daniel Smith government is considering allowing doctors to work simultaneously in the public Medicare system and in private clinics. Source: Canada Healthwatch
If these changes are approved, Alberta will become the first province in Canada where dual practice will be officially permitted by law.
In brief: what they plan to change
The proposed amendments to the Alberta Health Care Insurance Act provide for the creation of a hybrid healthcare model.
According to the leak, doctors will be divided into three categories:
- Those who work only in the public system and are paid at rates set by the province.
- Those who work only privately, setting their own prices for their services.
- So-called “flexibly participating physicians” — doctors who will be able to decide on a case-by-case basis whether to treat a patient in the public system or privately for a separate fee.
The government will have the authority to determine which services a doctor can provide privately and which only in the public system.
For privately paid services, doctors will be required to:
- inform patients in writing about the cost;
- inform them that a similar service may be available free of charge in the public system;
- obtain the patient's written consent.
The bill has not yet been submitted to the legislature: officials confirm that changes to the legislation are being prepared but refuse to comment on the details until the document is officially registered.
How the hybrid model will work
- Doctors only in the public system The first category is doctors who will continue to work as they do now:
- enter into contracts with the province;
- bill the Alberta Health Care Insurance Plan (AHCIP) at approved rates;
- are not allowed to charge patients extra for covered services.
For most family doctors and specialists, this model is standard today.
- Completely private doctors The second category is doctors who completely refuse to participate in the public system:
- do not bill AHCIP;
- set their own prices;
- can work in private clinics or their own practices.
This option is formally possible now, but very few doctors in Canada use it, as it means a complete loss of access to public funding and patients who are not willing to pay out of pocket.
- Flexibly participating physicians The most controversial new category is “flexibly participating physicians.” It is this category that makes Alberta's model unique in Canada:
- Physicians will be able to work in both the public and private systems simultaneously.
- For each patient or procedure, the doctor will be able to decide:
- whether to bill the public plan (AHCIP),
- whether to offer the patient private payment;
- the doctor will have to inform the patient in writing about the cost of the private service and the possibility of receiving it free of charge in the public system, and obtain separate consent.
The Montreal Economic Institute (MEI), which has publicly supported this model, argues that mixed practice in European countries allows for:
- an increase in the total number of hours worked by doctors;
- expanded access to medical care;
- no reduction in the participation of doctors in the public system.
Why is this so controversial?
Arguments of supporters
Supporters of the changes point to:
- reduced queues and waiting times for scheduled surgeries and consultations;
- an additional incentive for doctors to stay in Alberta rather than move to other provinces or abroad;
- the opportunity to attract private investment in medical infrastructure, particularly in diagnostics and surgery.
Supporters also point to the experience of Denmark and other European countries, where doctors can have both public and private practices, while maintaining universal coverage and affordable access to services. Source: troymedia.com
Critics' arguments
Opponents, including the Canadian Medical Association (CMA) and a number of public organizations, warn that the creation of a parallel private system will:
- exacerbate the shortage of personnel in the public system if doctors begin to devote more time to well-paid private patients;
- increase inequality of access: those with money or additional insurance will be able to get help faster;
- effectively force people to pay twice — through taxes to the public system and out of their own pockets for private services;
- may violate the principles of the Canada Health Act, which prohibits additional payments for services already covered by public insurance and requires equal access for all.
In its official statement, the CMA explicitly warns that where a parallel private system coexists with a public one, outcomes are worse and access is poorer, and calls on the Alberta government to reconsider its plans.
Some experts point out that such a model could be seen as a two-tier system that contradicts the spirit of universal healthcare in Canada and potentially creates risks of violating the Canada Health Act.
Is it legal to allow doctors to work in two systems?
Today, most Canadian provinces effectively prohibit dual practice: doctors either work in the public system or move entirely to the private sector. This model is one of the tools that limits the development of a duplicate private market for basic medical services.
Alberta's proposal will take a different approach:
- doctors will be able to legally combine public and private practice;
- the province will try to regulate this through:
- restrictions on the list of services that can be provided privately,
- transparency requirements for patients.
Whether such a scheme will comply with the Canada Health Act and how the federal government will react to it are open questions.
What the Alberta government says
The minister responsible for primary care confirmed that the bill is being prepared but declined to disclose its contents until it is officially tabled in the legislature. He stated only that the government's goal is to increase access to medical care and reduce wait times. Source: Global News
As of the time of writing, the official text of the bill is not available on the government website. All information comes from:
- a leaked draft amendment dated November 5, 2025;
- publications by The Globe and Mail, Global News, and other media outlets;
- statements by professional associations, including the CMA.
What this means for patients in Alberta (including newcomers)
If the bill is introduced and passed in its current form, the following consequences are possible:
- There will be more options for accessing doctors and surgeries — at an additional cost, but with potentially shorter waiting lists.
- For people with lower incomes or without additional insurance, the risk is that the best specialists may devote part of their time to paying patients, and waiting times in the public system will increase.
- For new immigrants and refugees who rely on AHCIP, it will be critical to understand:
- which services will continue to be fully covered by the public system;
- that when a doctor offers a private option, it is the patient's right, not their obligation;
- that it is always possible to ask: “Can I get this service in the public system and what are the approximate waiting times?”
What's next
At this stage:
- the bill has not yet been registered;
- the text may change before it is submitted to the Legislative Assembly;
- professional associations and community organizations are already preparing campaigns for or against the reform.
A heated political and legal debate is expected — from possible references to the Canada Health Act to lawsuits if the reform goes too far in the direction of a two-tier system.
Important: This information is based on the draft bill and public statements at the time of publication. Details may change before the laws are passed. For practical decisions regarding medical services, always check the latest information on Alberta's official government resources or consult your doctor.