Alberta intends to allow physicians working in the province’s public health care system to simultaneously offer services in a parallel private market, according to confidential draft legislation obtained by The Globe and Mail.
Premier
Danielle Smith’s government has prepared draft amendments that would transform the Alberta Health Care Insurance Act and establish a model for medicine unlike any in the country. No other Canadian province allows doctors to offer care under both systems at the same time.
Ms. Smith has long pledged to overhaul Alberta’s health care, but neither she nor her United Conservative Party have floated adjustments as significant as those contained in the draft amendments. The proposals could nurture a hybrid system where some Albertans have better access to care than those who rely on the public option, according to experts who reviewed the draft amendments. The changes could also create an environment where private insurance companies could flourish, the experts said.
“This is definitely two-tiered medicine,” said Braden Manns, a professor of health policy at the University of Alberta.
The document obtained by The Globe is marked as draft 11, dated Nov. 5, and contains notes from bureaucrats that must be resolved before the amendments are ready for the assembly floor.
Maddison McKee, a spokeswoman for Adriana LaGrange, Alberta’s Minister of Primary and Preventative Health Services, would not answer questions about the draft amendments. However, she said the UCP remains committed to its pledge to protect public health care, stating “that under no circumstances will any Albertan ever have to pay out-of-pocket to see their family doctor or to get the medical treatment they need.”
Alberta’s draft amendments would create three categories of physicians: those billing the public purse for their services, paid at rates set by the government; those setting their own rates and billing patients privately; and those toggling between the public and private systems.
The third option is what makes Alberta’s proposal unique. Provinces that allow doctors to opt out of medicare in favour of private billing – including Alberta, under its existing rules – do not allow those physicians to concurrently participate in the public system. The Globe in 2023 counted three physicians in Alberta who opted out of the public system.
Quebec has the most established private health care system in the country, with about 550 family doctors, or 6 per cent of general practitioners in the province, opting out of the publicly funded model, Dr. Manns said.
The number of physicians opting out of medicare in Quebec is making it more difficult for those in need of medical attention, but without financial means, to access services, Dr. Manns added. Patients in the public system tend to have more complex needs, which require more time and funding to address. But with fewer doctors serving this population, wait times increase, driving demand for private alternatives.
To address the shortfall, Quebec in April passed a law requiring new doctors to
work in the public system for five years before they are allowed to participate in the private stream.
Jon Meddings, the past dean at the University of Calgary’s medical school, said few doctors opt out of medicare in Alberta because, under the existing legislation, it is financially risky.
“This has protected our public system,” he said.
Alberta’s proposed hybrid system would give physicians who want to test the private waters opportunity to do so without risking their entire income, because continued access to the public system guarantees work.
A doctor working in both systems, dubbed a “flexibly-participating physician” under the draft amendments, may “decide on a case-by-case basis whether to provide a service” under the private or public model.
Flexibly-participating doctors are not required to notify the government of “the specific services” they intend to offer under each system, or “the specific circumstances” under which they intend to provide public or private care, according to the draft amendments.
Monika Dutt, a family doctor in Nova Scotia and health policy doctoral candidate at McMaster University, said the draft amendments could accelerate the shift toward private health care.
“It is making it very easy for physicians to charge patients privately whatever they may decide to charge for that service,” she said.
The proposed changes would add paperwork for both the doctors and patients. A doctor working exclusively in the private realm, or in both the public and private tracts, must provide patients with certain information before providing health care services under the out-of-pocket system. The checklist includes the amount the patient will be charged and an explanation that the patient, if eligible for the service under the public system, may receive the care at the government’s expense from certain doctors.
The patient must then agree – in writing – to the procedure and price quoted by the doctor, as well as receipt of the information provided by the physician. Only then can the doctor provide care under the private system, according to the draft amendments.
The draft amendments contain clauses that would give the government the power to restrict the types of services that doctors can offer under the private system in order to ensure “adequate provision” of publicly funded services. The draft amendments would also empower the government to establish the circumstances under which doctors can bill privately.
The draft amendments prohibit a practice known as “extra billing,” which is also outlawed under Alberta’s existing rules. Doctors providing services paid for by the public system are not permitted to top up their revenue by charging the patient for the same care, according to the draft amendments.
