On June 18, Premier Danielle Smith and Minister of Hospital and Surgical Health Services Adriana LaGrange announced a "dual practice" policy for Alberta doctors, allowing them to treat both publicly and privately funded patients simultaneously. Critics argue this move violates the Canada Health Act and threatens the province's health-care system.
What is dual practice?
Dual practice enables doctors to choose which patients pay higher private fees for faster care and which remain in the public queue. Since medicare's inception, such practice has been prohibited to prevent a two-tier system. The policy does not create new physicians, nurses, hospitals, or medical schools; instead, it redirects limited health-care workers to private-pay patients, worsening waits for those relying on public care.
International evidence against dual practice
According to Danyaal Raza and Braden Manns, writing in an opinion piece, evidence from Europe, Australia, and the Cambie Surgeries trial in British Columbia consistently shows parallel private systems do not reduce public wait times—they increase them by diverting resources. Dual practice also creates incentives for doctors to inflate public wait lists to make private care more appealing.
The authors note that promised safeguards are unlikely to work. In the U.K., a cap on private income for physicians was routinely violated until abandoned. Ireland's limit on time spent with private patients was regularly breached, according to its auditor general and investigative journalists. The Alberta Medical Association has proposed 70 safeguards, but even that assumes safeguards are workable.
Federal response needed
Legal and health policy experts agree the legislation violates the Canada Health Act. Prime Minister Mark Carney and Federal Health Minister Marjorie Michel can activate Section 14 of the Act, imposing financial penalties including withholding all health-transfer payments. For Alberta, that represents $7 billion per year—nearly a quarter of the provincial health budget. In the past, even the threat of withholding payments has corrected provinces that threaten access to care.
