Four former Alberta medical school deans have called on the federal government to intervene in the province’s controversial dual-practice health care model, warning that it undermines the principles of the Canada Health Act. The system, which came into effect on September 1, allows certain surgical specialists to bill both the public health system and charge privately for procedures such as hip and knee replacements, cataract surgery, and dermatology services.
In a letter sent on Tuesday to Prime Minister Mark Carney and Alberta Premier Danielle Smith, Tom Feasby, Jon Meddings, Eldon Smith, and Tom Marrie—formerly affiliated with the universities of Calgary and Alberta—expressed “deep concern” about Alberta’s approach. They argue the policy risks creating a two-tier system where patients with the ability to pay receive faster care, contrary to the Canada Health Act’s requirement for equitable access to medically necessary services.
Alberta’s model is distinct within Canada, allowing eligible physicians to toggle between publicly funded care and private billing. Critics, including the Canadian Medical Association and its Alberta branch, say this arrangement could divert resources and priority away from publicly funded patients. In March, a coalition of 23 national health and labor organizations urged federal action against the policy.
Dr. Jon Meddings explained that while dual practice exists successfully in other countries, Alberta lacks sufficient beds and physicians to support such a system fairly. He noted the key issue: when privately paying patients receive care, they essentially take resources away from publicly insured patients who require treatment, exacerbating wait times in the public system.
Federal Health Minister Marjorie Michel has voiced concern over how Alberta’s model aligns with the Canada Health Act but has refrained from detailed public commentary. Her office confirmed ongoing discussions with Adriana LaGrange, Alberta’s Minister of Hospital and Surgical Health Services, aimed at preserving access to medically necessary care while respecting provincial jurisdiction.
Alberta officials maintain that the federal government should respect their authority to manage health care delivery. A spokesperson for Minister LaGrange emphasized that the dual-practice model does not violate the Canada Health Act and argued it expands access without forcing Albertans to pay out-of-pocket for medically necessary procedures. The province asserts the model is intended to alleviate pressure on the public system and provide patients with more choices.
As of mid-September, around 400 physicians had expressed interest in joining the dual-practice program, with formal applications underway and surgeries expected to commence later this fall.
The letter’s authors recommended federal intervention to uphold the Canada Health Act’s core principles. Dr. Meddings outlined two possible federal responses: one involves using moral persuasion to encourage Alberta to modify its legislation; the other, described as a “nuclear option,” would be to reduce or withhold federal health transfer payments to the province, a measure permitted if provincial policies breach the Canada Health Act.
The debate continues amid growing concerns about maintaining equitable access to publicly funded health care across Canada.