The Decibel - The controversial push to expand private health care in Alberta

Episode Date: November 24, 2025

No Canadian province allows doctors to offer care under both private and public systems – but leaked draft legislation obtained by The Globe and Mail shows Alberta is trying to change that. The province says it’s proposing the change in an effort to reduce surgery wait times and retain health care workers. But experts say it could result in a two-tiered medical system.Today, Carrie Tait, a reporter in The Globe’s Calgary bureau, joins The Decibel. She broke the story last week, and she’ll tell us what she’s learned about the province’s plan, the impact a public-private model could have on access to health care and why some critics say this could violate the Canada Health Act.Questions? Comments? Ideas? E-mail us at [e-mail] Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Canada's universal public health care system has long been a point of pride. Even with strains on the system in recent years, 60% of Canadians say it's something they continue to be proud of. That's according to an abacus poll from July. Private care is still scarce in most of the country, but that could be changing. Last week, the globe obtained confidential draft legislation. it revealed that Alberta's government is planning to allow doctors to deliver public and private services at the same time. The proposed hybrid model could see doctors in the province work in the public system while also maintaining a fully private practice. No other province allows physicians to operate this way.

So instead of a surgeon being limited to performing, say, 1,000 surgeries a year due to health system funding constraints, That doctor could also perform an additional two or three hundred more surgeries for patients who can afford to pay for the cost themselves or that have an employer insurance plan that covers the cost. That's Alberta Premier Danielle Smith in a video posted to social media announcing the plan. It ran a day after the Globe's report. Because health care shouldn't be about blind and outdated ideologies or politics. It should be about providing all Albertans with access to the best health care possible

when and where they need it. And that is exactly what Alberta's government is going to do. Today, Carrie Tate is here. She's a reporter in the Globe's Calgary Bureau and broke this story. She'll tell us what she's learned about this plan, whether a public-private model could actually improve access to health care, and why some experts are saying it could lead to a two-tiered system. I'm Allie Graham, sitting in for Cheryl Sutherland. and this is the decibel from the Globe and Mail. Hi, Carrie. Thanks for joining us. Hi, thanks for having me.

So, first of all, was this expected? No. Daniel Smith has been very clear in her whole political career that she thinks the Alberta health care system needs to be torn down and rebuilt. And that has been her big political promise to redesign. the health care system, address weight times, all of that. But within that, she has never once floated something this dramatic as a shift to basically a stream for public and private competition to go to the doctor. Okay. And we'll get into the big reactions this proposal has received and how the province has responded to your reporting so far. But first, can you tell me what we know about how

this public-private hybrid model would work? There's still a lot of questions that need to be addressed. But how this works and what makes it different is the draft amendments that the global obtained show that there would be three categories of doctors. You could choose to be exclusively in the private realm, exclusively in the public system, the one we have now, or you could toggle back and forth. You could offer some services where it would be. paid for privately, whether out of somebody's pocket or buy an insurance company. And then you can

offer publicly in which the government would pay for your services for that person in the way that it happens now. No other system in Canada allows doctors to simultaneously toggle back and forth. You have to opt in or opt out. So that's what makes this different. And we know that doctors in the province already have the option to fully opt out and go private. Do we know how many doctors in the province are currently doing that? In Alberta, it's really, really small. In most provinces, other than Quebec, it's really small. The globe found in 2023, there was like three doctors in Alberta that were private only. There's maybe like a handful. Do we know why that is? The reason that you don't have doctors opting for the private system when you have to choose one or the

is because it is risky. There's no market that we already know of people willing to pay. So you might opt out of the public system, you know, put your entire income at risk and find nobody wants to pay you when they could just go to the public system. Now in Quebec, it's more robust in part because it's just been there longer and it came as a result of a Supreme Court decision. And once it exists, then it's sort of like snowballs, right? So Quebec is just further down. that road and that's why you see it there and you don't see it so much in the other provinces. Okay, good to know. And so would this flexible category, if we do see it come to fruition, would it take the financial risk away if someone wanted to go private then?

It looks as though that's the intent that by being able to toggle back and forth, if I'm a doctor and I want to make more money or make myself more accessible after hours or for whatever reason it might be, you can offer those services and find out if there's demand. And if there's no demand, well, no big deal. You just go back to work where you went the day before or how you did it the day before. There's a safety net there. And that was part of what protected the public system that by forcing doctors to choose one or the other, it put income at risk. And this takes that out.

And then so it allows the private market to grow and then establish itself. And then once it starts growing, then that demand would rise. But it's taking the plunge that's the risk, and this eliminates that. How was the province responded to your reporting since this past Tuesday? And what have they said further about this hybrid model? So we published this Tuesday. And the government's response, when I first reached out to them for questions, First, they wouldn't comment on the draft amendments, but they did say that the United

Conservative Party remains committed to its promise that no Albertan would have to use their credit card to pay to go to a family doctor. Now, that's very different because you don't have to pay to go to a family doctor under this dual track system, but you could pay. In the days that followed, the Alberta government released, you know, one of the, those really slick, flashy videos, it's Premier Danielle Smith and one of the four health ministers, Matt Jones, he's in charge of hospitals and surgeries. And that's where we saw a little bit more information about what they have in mind. And so they were talking about reforming the

system and they focused on surgeries and sort of sounded like orthopedic surgeries, hips, knees, shoulder replacements, that kind of thing. To permit surgeons and supporting surgical. professionals like anesthesiologists to perform both publicly and privately funded knee, hip, eye, shoulder, and other elective surgeries. And while we do not have, you know, a press release or the draft legislation that would make that happen, it does give us insight in what they intend to do once they get the legislative framework in place and how they intend to narrow the plan. And it's important to mention,

none of this has been tabled. The draft that you obtained was, I think, draft 11. Right. I have draft 11. It was described to me as like, yes, this is pretty advanced. There's still some pieces they have to polish. But it's also very clear. Like, there's still room for the draft that I have to change. But it appears as though there would be companion, either legislation or regulations that would sort of continue to indicate how they intend to use this. It does not sound as though the government intends to make this dual track system for all doctors of all specialties. It looks as though they want to limit it to surgeries and probably within that a narrow band, a type of surgery. But we don't know that that's yet to come. Do we know anything

about possible guardrails? Like, have they said anything about, like, would there be a ratio for if you choose the flexible track, you have to do a certain amount in the public system, a certain in the private in order to maintain that? Because, of course, we have not seen the legislation they intend and then the companion pieces of regulation and all of that. We don't know. There are mechanisms that the government could use to implement things like, and Daniel Smith tossed out these types of ideas of perhaps you can only work in the private

system after you work X number of hours for the public system or you perform X number of surgeries. We will also protect public workforce capacity with the ability to mandate that surgeons in dual practice must perform a dedicated amount or ratio of surgeries in the public system to be eligible to perform surgeries privately. The government does have the power to implement those types of restraints. Within the amendments that the globe obtained, it does indicate that the government will have the power, if there's a shortage, say, of a doctor who performs whatever type of procedure, that the government can set limitations on the private market or doctor's ability to participate in the private market. We don't know what the limitations

are, if they will use any of those, all of that. Still, they have to work it out. But they did make the point that it is possible. Okay. And just to clarify, because this would be a big push into private, especially for surgeries, but I know that the province was already offering surgeries through private clinics. Could you explain how that's different? Alberta has facilities. They're called chartered surgical facilities. They're essentially private companies can own clinics where low risk or less complex procedures can be performed. So day surgeries, hip knees, again, cataracts is a popular sort of surgery that's. performed in these types of facilities. They are owned privately, but the procedures are paid for by

the public system. So you don't really even know you're in a private clinic. It's not like you are a customer. You still have this patient type relationship. Your credit card never comes out. They are paid for by the provincial health agency. So this would be setting up a system where the patient or the patient's insurance, would be paying directly rather than the public system paying. So it really comes down to who's paying. Do we know why Alberta is proposing such significant changes? That's a great question. I don't think we know why other than Alberta and the premier, just like any province in any

premier, is desperately trying to solve a difficult problem. Alberta, Premier Smith and, you know, her contemporaries have grappled with how do you cut weight times. How do we make the health care system better? Alberta is saying, you know what? We're going to try something very different. This government knows not everyone may like it. That is a space that the government is comfortable in. And they do make a good point that what they have been trying maybe hasn't been working so great.

So let's test something else out. You've mentioned wait times. I know that in this seven-minute-long video that Daniel Smith and the UCP put out, they'd also mention this effort to perhaps make doctors happier, attract new doctors, retain them. So Alberta, again, like lots of other jurisdictions, has been struggling with retaining doctors. In Alberta, there's been a big fight over physician compensation. This solves that. Oh, you don't like what you're being paid? Fine. Go charge somebody privately. Of course, it does seem as though the government wants to limit

this to certain types of surgeries, but it does establish the framework where that could be expanded to other areas of medicine. So the province would argue giving doctors the choice and the opportunity to make more money while still serving the public system would be attractive to doctors from Ontario, Montana, wherever, and that it could bring more doctors to the province, which the proponent, people who are fans of this would argue, can help both the private and the public system. But part of the argument, like, why this runs a risk of being damaging, is that the patients who have the means to pay or are insured tend to be better off less complex health concerns, which means those in the public system, you know,

because they have more challenging medical needs, that extends that wait list. And then there's fewer doctors serving that population and that can end up increasing the costs in the public system. So even if you are a resident in Alberta who uses the private system and you pay out of your pocket, the health care costs that you pay as a taxpayer still go up. You don't solve the problem of, did this become less expensive? We'll be right back. So, Carrie, we've heard concerns from the health care sector, from doctors in province, as well as throughout Canada, that this could lead to an increase in. privatization in the province's health care system.

Could you tell me what we've heard specifically from doctors and medical experts about this system and specifically about the concern that this could violate the Canada Health Act? Well, the government would argue that while they're opening up the private stream, that it doesn't necessarily come at the detriment of the public option. That's where the debate is, is how does this affect the public option? What it means for the Canada Health Act is, again, something that's being debated in theory, because surely the United Conservative Party is aware that it has to figure out a way to comply with that. It's not as though, you know, they don't have lawyers reading up on this and trying to figure it out.

And so the cost out of the government treasury for health care may drop in the event that you have people opting to pay privately. the offsetting factor is that the health transfers that Ottawa sends to Alberta may also drop. And so that's where the argument becomes that it doesn't necessarily mean it's less expensive for the residents of Alberta. The line item in the government budget might drop, but there's the offsetting one where the money coming in to direct towards health care also drops. again, this is something that we need the government to provide, you know, the fine print, and we need Ottawa to provide its response and how it views what Alberta actually publishes as legislation to be tabled. Okay. And for anyone who doesn't know, the Canada Health Act essentially is the rules by which provinces get money for their health care systems. And so specifically, it sounds like this violation could be about the rule in the CHA that states that doctors can't charge privately for care that's otherwise publicly covered. You've mentioned Ottawa's response.

I'm curious, have we heard anything from Ottawa? We've sort of heard the very generic. We're paying attention to what they're doing or we're working with our counterparts in Edmonton. that's kind of about as specific as governments get in something like this. And it is difficult for Ottawa to comment on something that Alberta has not finalized. This is public because the globe broke the story and forced the conversation. And rather than waiting until Alberta has the final version of, hey, this is the idea that we are pursuing. This puts it to the government to have that discussion with residents now. And it does put, I think, a little more heat.

on Ottawa that something is coming. But there's no point in Ottawa making any announcements until Alberta makes its move. The system that Alberta is proposing would be, of course, as we said, unique. But privatization is a growing reality in Canada. Right now, Quebec has the most established private system, as you've said. What do we know about how access to public health care has been affected in that province? So in Quebec, this is like an example. And again, this is from the family physician side. So keep in mind, it does appear as though Alberta's intention is not to allow every doctor of every kind, every specialty to do this, but to narrow it to surgeons. But Quebec has about 550 family doctors working in the private stream.

That's about 6% of the general practitioners in the province. And because health care, care there and access to care has been under such pressure. Quebec in April introduced legislation that required doctors to work for five years in the public system before they were eligible to work in the private system. So while they have a private system and a robust private stream, it has dragged the public system to the point that the government had to retroactively patch a hole in the system that the Supreme Court sort of had forced the province into. Alberta, I think, would argue that the difference is that with the flexible model, the province is not precluding doctors who charge privately from also offering services publicly.

So the comparable would be like those 550 doctors in Quebec cannot work in the public system. Alberta would argue those 550 doctors could work in the public system. Gary, is there any sense that Alberta's plan here could inspire other provinces to follow suit? What kind of knock-on effect could this have nationally? Well, I think, let's say it worked. Let's say Alberta, you know, it was a fantastic system and they attracted doctors from all over the place. Of course it would inspire other provinces to do the same. You want to find the model that works. I don't think, I think that would be, if it worked, And if it inspired others, that would be a good outcome.

So we don't really know what it is. It'll be interesting to see what happens as this sort of starts, the launch, the launch, early phases, early years of how other provinces respond should the system attract the medical staff that Alberta believes it will. There could be a war over medical professionals, which there already is that war. Does this give Alberta the edge that it believes? That we'll see. But all of that, I think, is years away. Like, this doesn't change things overnight. There still takes time for the market to develop and for people to adjust to the idea.

This is a massive change of mindset for any Canadian. So, Carrie, as you've mentioned, this could be years away. Do we have any sense of how likely this would be to actually become law? I expect that this is where Alberta's headed. And we got the answer when Danielle Smith and Minister Matt Jones put out a seven-minute video. They didn't do that just like floating trial balloons. They were saying, we're going to do this. Just lastly here, Carrie, you've mentioned critiques from medical associations from doctors with and the province and without about this dual practice model that could come forward in Alberta.

But of course, health care systems across the country are struggling with similar issues, as you've mentioned. What do experts say need to be done, if not this? I don't know if there is a really simple answer or we would all be trying it. Experts do continue to go back to a staffing issue and attracting talent and all of that. I don't think that there's one answer or we wouldn't be having this discussion. Carrie, thanks so much for joining us today. It was a pleasure. That was Carrie Tate, a staff reporter in the Globe's Calgary Bureau.

That's it for today. I'm Ali Graham, in for Cheryl Sutherland. I produced The Decible with Madeline White and Bihal Stein. Dave Crosby edits the show. Adrian Chung is our senior producer, and Angela Pichenza is our executive editor. Thank you for listening.