Alberta's publicly funded health-care system faces a fundamental threat from the provincial government's move toward a two-tier model, analysts warn. Premier Danielle Smith's administration, over the past four years, has reorganized and redirected health funding, pushing tax dollars toward private delivery—a direction that conflicts with the principles of the Canada Health Act.
The Core Mechanism: Bill 11 and Dual Practice
The trajectory of this overhaul is crystallized in Bill 11, the Health Statutes Amendment Act. This legislation would permit physicians to operate under a dual-practice model. In essence, doctors could work within the public system while also charging patients privately for the same medical procedures.
The Canadian Medical Association has sounded the alarm, stating this model would undermine the public care system in Alberta. Proponents argue it could reduce wait times by having doctors treat publicly insured patients by day and private-paying patients after hours, theoretically increasing procedure volumes without additional public expenditure.
The Fatal Flaw in the Logic
This argument, however, rests on a critical misconception: that health-care workers and infrastructure like operating rooms are an unlimited resource. Every hour a surgeon, nurse, or specialist spends in a private clinic is an hour removed from the public hospital.
Instead of creating new capacity, the dual-practice model simply shifts finite resources toward those who can afford to pay. This leaves the public system, already under immense strain, with even greater challenges. Alarmingly, this shift is being subsidized with public money, as Alberta already uses tax dollars to pay private clinics for insured surgeries.
Bill 11 would further finance competition against a public system already on the brink of collapse.
Fragmentation and the Real Crisis
The Smith government's restructuring has also involved breaking the unified Alberta Health Services into smaller, separate agencies. This fragmentation increases management costs, billing complexity, and bureaucracy. It makes it harder to efficiently reassign staff, beds, and equipment across the province where they are most urgently needed.
Despite a "public health-care guarantee" from the government, these reforms ignore the central, man-made crisis: Alberta does not have enough doctors.
This shortage is not accidental. In 2020, the province used Bill 21 to unilaterally tear up its master agreement with physicians. It imposed new billing rules by law, cut compensation for complex patient visits, and capped daily billing amounts. While the government cited cost control, family doctors and rural clinics warned the changes would cripple the financial viability of their practices, driving physicians away.
The push for a two-tier system, therefore, is seen by critics as a distraction from—and an exacerbation of—the foundational problem of physician retention and recruitment. Without solving the doctor shortage, any structural change risks accelerating the public system's decline.
