Will Alberta’s two-tier surgery system mean longer employee wait times?

HR professionals overseeing benefits plans, disability claims and workforce health in Alberta should prepare for longer employee wait times for surgery, as the province’s two-tier surgical system is set to begin in September, according to a non-profit research institute.

The Canadian Centre for Policy Alternatives (CCPA) warns that the system will draw nurses and anesthesiologists away from public hospitals and open the door to a U.S.-style private health insurance market for medically necessary care.

The report – authored by CCPA senior researcher Andrew Longhurst – follows Alberta's release of the procedures slated for private-pay delivery, including hip and knee replacements, cataract surgery and hernia repair. The province will run an expression-of-interest process this summer, after which participating surgeons and the for-profit facilities in which they may hold investment interests can charge patients whatever rate they choose to facilitate queue jumping.

Recently, Alberta became 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 the CCPA.

Strain on the public system

The procedures rely heavily on nurses and anesthesiologists already in short supply in public hospitals, and the CCPA report warns shortages will worsen as for-profit facilities draw more public resources.

"The empirical research evidence shows that a private-pay tier draws resources away from the public sector, increasing public wait times," Longhurst writes.

The report notes that since the Alberta Surgical Initiative, median wait times for nine of 11 key procedures have increased, including all cancer surgeries — a trend that has implications for disability claim duration and benefits utilization.

Longhurst adds that the government has not released the regulations meant to accompany the legislation, including promised guardrails such as minimum public-system work hours, and questions how they would be enforced given that Alberta surgeons work as independent contractors without employment contracts.

Compensation and funding

"Two-tier health care plays to the greed of some surgeons looking to substantially increase their already generous public compensation," Longhurst argues.

According to Canadian Institute for Health Information data cited in the report, surgeons in Alberta averaged $704,673 in gross clinical payments in 2023-24, with ophthalmologists at $1,519,108 and orthopedic surgeons at $550,421. 

The report adds that real per capita hospital spending fell 4% between 2014 and 2023, making Alberta the only large province to cut such spending over the period.

Private insurance market

Alberta is permitting "dual physician practice," letting surgeons bill the public plan and work privately at the same time, reports Longhurst. 

"Alberta is the first province to allow dual practice and explicitly encourage an American-style private health insurance market for medically necessary care," the report states.

The CCPA disputes the government's claim that the model mirrors western Europe, noting "No other province allows dual practice similar to Alberta's new model." For benefits professionals, a private market for medically necessary surgery raises the prospect of new pressure to fund private surgical access through workplace plans.

The report says the federal government may withhold Alberta's portion of the Canada Health Transfer, which it puts at about 28% of the province's health care budget. 

Any reduction that further strains public capacity would carry consequences for employee access to care.

Also, long medical wait times cost Canadians more than $4.2 billion in lost wages and productivity last year, according to a Fraser Institute report.

Surgical wait times: Alberta vs. Canada (% of patients treated within recommended time)

Source: CIHI (Wait times for priority procedures in Canada, 2025)