Move could have implications for future benefit design, regional disparities in access to care and long‑term workforce health costs
Alberta has become the first province in Canada to legislate a two‑tier health‑care system and enable private health insurance for medically necessary services — a shift that analysts say could reshape costs and access for employers and workers.
On Dec. 18, 2025, Premier Danielle Smith’s government passed Bill 11, the Health Statutes Amendment Act. The law creates a framework for “dual practice” by physicians and opens the door to a private insurance market for core medical services, according to a report from the Canadian Centre for Policy Alternatives (CCPA).
Previously, Adriana LaGrange, Alberta’s Minister of Primary and Preventative Health Services, spoke in a Facebook post about the benefit of the move: “This proven approach will mean more surgeries, faster care, and shorter waits for everyone—while keeping our Public Health Care Guarantee strong. No Albertan will ever have to pay out-of-pocket for family doctor visits or medically necessary treatments.”
Alberta 'at odds with Canada Health Act'
In the CCPA report, Andrew Longhurst, a senior researcher and political economist at the CCPA, and Rebecca Graff‑McRae, a research manager at the Parkland Institute at the University of Alberta, say that Alberta is “the first province to legislate two‑tier health care and private health insurance for medically necessary services,” warning it could mark “the end of Canadian medicare as we know it” if other provinces follow.
The CCPA argues that Bill 11 is “at odds with the Canada Health Act,” particularly its principles of universality and accessibility, by encouraging preferential access to medically necessary care through private payment. The report warns that Alberta’s approach could jeopardise federal Canada Health Transfer funding and spark a “political and legal confrontation with Ottawa.”
The authors also see “a growing threat" if other provinces join Alberta with similar legislation, suggesting that broader adoption could lead to “the dismantling of the Canada Health Act as the federal framework that upholds provincial public health insurance plans.”
The amendments introduced in Bill 11 would “reflect the government’s commitment to implementing a refocused health care system that recognizes the province’s evolving needs, empowers health care professionals, and supports improved health outcomes for Albertans,” the Alberta government previously said.
For HR professionals, the move raises questions about future benefit design, regional disparities in access to care and long‑term workforce health costs.
Dual practice and pay‑for‑access care
At the core of Bill 11 is a new category of “flexibly participating physicians” who may work simultaneously in the publicly funded system and the private‑pay market. These doctors and surgeons can bill the provincial insurance plan for insured services while also charging patients directly for “non‑plan services” on a case‑by‑case basis, according to the CCPA report.
“No other province in Canada allows this,” the CCPA reports. The authors say it establishes “a system that provides faster access to those with the ability to pay privately, and longer public wait times for those who are unable to pay for queue jumping.”
While the Alberta government has suggested dual practice will be limited by regulation to certain surgical specialities, Longhurst and Graff‑McRae point out that “the legislation as passed allows all physicians and surgeons to engage in dual practice.” They argue that requiring doctors to disclose costs does not resolve “an inherent power imbalance in the doctor‑patient relationship,” with vulnerable patients feeling compelled to pay to secure timely treatment.
For HR leaders, that raises the risk of a widening gap in health outcomes between higher‑income employees who can afford faster access and lower‑paid staff who must rely solely on longer public queues.
New private market for medically necessary services
The CCPA concludes that Bill 11 “creates Canada’s first private insurance market for medically necessary care,” fundamentally changing how health services may be financed. When dual practice is permitted, the report says, “it encourages high‑income patients to buy private health insurance to cover these new costs.”
“We can look at the United States to see how much a system dominated by private insurance and profit‑taking drives up health care costs for patients, employers, and government,” the authors write. As private insurers and investor‑owned facilities seek profits, “the cost of the same basket of services is bid up by increasing profits, often disguised as ‘administrative costs.’” Governments then come under pressure to narrow what the public system covers, which the CCPA describes as “a race to the bottom.”
Bill 11 also explicitly allows and encourages group insurance plans for private‑pay services. “The major aim of Bill 11 is to encourage the creation of a much larger private health insurance market, likely encouraging existing employer‑sponsored insurance plans to expand into medically necessary health care,” the report states.
Longer public wait times and new hospital charges
The Alberta government has argued that more private options will reduce public wait times. Longhurst and Graff‑McRae, citing international evidence, say the opposite is more likely. They highlight research showing that “public‑sector waiting lists and times are longer in nations with parallel private sectors” and that a private tier can “draw resources out of the public sector and/or put in place incentives that have the effect of increasing waits.”
The report argues that the business case for private‑pay medically necessary services “requires long public wait times,” creating “a perverse incentive for physicians and surgeons to make their public wait lists longer in order to drum up business for their private‑pay work.”
People waiting for medically necessary treatment lost an estimated $5.2 billion in productivity in 2024, reported the Fraser Institute.
Bill 11 also continues an “unbundling” of hospital care by creating categories of “non‑insured hospital services” and “enhanced goods and services” for which patients can be billed. “What are possible ‘non‑insured hospital services’ and ‘enhanced goods and services’? We don’t know because the government is withholding this information until it passes the accompanying regulations at a later date,” the CCPA report says.
Just over half of Canadian employers feel successful in containing healthcare costs, according to a previous report.
