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On December 18, 2025, Alberta became the first province to legislate two-tier health care which is defined as a system that provides faster access to those with the ability to pay for medically necessary services, and thus, longer public wait times for those unable to pay for queue jumping.
Alberta restructured their provincial health authority, transferred ownership of health care facilities, expanded for-profit surgical outsourcing, and made complex changes to the hospital funding model to create profit driven incentives.
Here are eight points about Alberta’s new two-tier health care system:
1. Dual Practice
Alberta will allow “dual practice” where doctors can work in both the public system and private-pay market, known to increase public wait times and create unequal access based on income.
2. First private insurance market for medically necessary care
Bill 11 creates an unrestricted private health insurance market, which is also likely to increase public health care costs to retain staff also providing services in in a for-profit system.
3. The introduction of private payment increases public wait times
The introduction of private payment for publicly insured services will increase public wait times as physicians and surgeons focus their time in the lucrative and less complex private-pay market.
4. User fees just like the USA
Under Bill 11, Alberta can determine which acute care programs will be available free of charge to patients and which services will require user fees.
5. The definition of a “hospital”
Bill 11 has introduced a new form of “hospital services facility” that may be owned and operated by a public, non-profit, or for-profit as a “health services facility operator.”
6. Private insurance market
Bill 11 encourages the creation of a much larger private health insurance market, inviting existing employer-sponsored insurance plans to expand into medically necessary health care.
7. Hospitals to compete for revenue from user fees and private health insurance
The Alberta government is creating health care insurance and provider markets where every patient is seen as a source of revenue.
8. Bill 11 contravenes the Canada Health Act
The Alberta government has effectively ended universal health care in that province by encouraging preferential access for medically necessary care through a private-pay market, in violation of the Canada Health Act.
If other provinces join Alberta in privatizing health care, a real possibility, we could see the dismantling of the Canada Health Act as the federal framework that upholds provincial public health insurance plans. This could end Canadian Medicare as we know it.
