Health Groups Warn Alberta’s Dual Practice Plan Could Lengthen Wait Times

Concerns are mounting over Alberta’s new health care strategy allowing physicians to operate in both public and private sectors. This plan, enacted through **Bill 11**, aims to permit doctors to bill the public health system while also charging some patients directly for services typically covered under public insurance. Several national health organizations are warning that this dual practice approach could exacerbate existing wait times for patients relying on the public health system.

The **Canadian Medical Association** (CMA), **Canadian Doctors for Medicare** (CDM), and the **Canadian Health Coalition** (CHC) have collectively expressed their opposition to the legislation. On **March 14, 2024**, CMA President **Dr. Margot Burnell** stated, “Doctors across Canada are deeply concerned about the Alberta government’s proposal to expand private health care.” She emphasized that allowing private payments for care would divert critical resources from the public system, leading to longer wait times and fewer available physicians.

Alberta’s Premier **Danielle Smith** defended the initiative, insisting it is designed to improve access to health care and reduce wait times. She reiterated that the province’s commitment to publicly funded care remains intact, saying, “Our priority is the public system, and we want to make sure that no one ever has to pay out of pocket for medically necessary care.” Smith explained that the model would allow physicians to treat a limited number of private patients when not engaged in public care.

The implications of this legislation are significant, according to Dr. Danyaal Raza, a family physician and board director with CDM. He asserted that Bill 11 could lead to a systematic shift in how Canadians access medical services. “Medicare is not just a policy; Medicare is a promise,” Raza remarked, highlighting that the health system should prioritize medical need over financial capability. He warned that the legislation would facilitate a formal two-tier system, where patients with the means to pay would receive expedited services.

As the debate continues, the CHC raised alarms that Alberta’s actions could set a concerning precedent for other provinces. Jason MacLean, the coalition’s chair, stated, “Bill 11 is a direct threat to those achievements,” referring to the principles outlined in the **Canada Health Act**. He indicated that the legislation’s potential to enable extra billing and allow wealthier patients to bypass waitlists violates the act’s core tenets of accessibility and universality.

Critics of the dual practice model are also citing workforce pressures as a major concern. **Dr. Braden Manns**, a health economist at the **University of Calgary**, pointed out that this is one of the most significant changes to the Canadian health care system since the Canada Health Act was enacted in **1984**. Manns explained that by allowing doctors to reserve appointment slots for those willing to pay, patients relying on the public system could face wait times ranging from three months to a year. He referenced data from jurisdictions like **Quebec** and **Manitoba**, where similar dual practice systems resulted in longer wait times for public patients.

In a 2005 study co-authored by Manns, it was revealed that patients paying for private cataract surgery waited approximately four weeks, while those relying solely on public services faced waits of up to **23 weeks** if their surgeon was involved in both public and private practice. The study underscored the concern that without an increase in health care professionals, introducing private-pay options could further strain public health resources.

In response to these criticisms, Premier Smith argued that the situation in Quebec differs from Alberta’s approach. She asserted that Alberta’s framework would not force doctors to choose between public and private practice entirely, which could prevent a mass exodus of physicians from public care.

As discussions surrounding Bill 11 advance within the current legislative session, the implications for Alberta’s health care landscape remain uncertain. With diverging views on the potential impact of dual practice, patients, health professionals, and policymakers will be closely monitoring the unfolding developments and their repercussions on the public health system.