Alberta defends public-private health care model as experts say it could violate Canada Health Act

The Alberta government defended its plan to introduce a public-private model for physicians on Tuesday, a proposal that health care experts say could contravene the Canada Health Act.

Alberta intends to introduce a hybrid model in health care where doctors could work in both systems simultaneously, The Globe and Mail revealed on Tuesday, according to confidential draft legislation. No other Canadian province allows physicians to toggle between the two systems.

Matt Jones, Minister of Hospital and Surgical Health Services, during Question Period, said the model has worked in other jurisdictions, listing countries such as Denmark and France. He also pointed to Quebec and New Brunswick, despite neither province operating a hybrid system similar to what Alberta is proposing.

Additionally, he said Alberta has already shown success with some private services.

“We’ve had great success in Alberta, augmenting the majority of our surgeries, which are provided in hospital – 80 per cent – with 20 per cent provided in our chartered surgical facilities,” said Mr. Jones.

Premier Danielle Smith ran in the last provincial election on a promise to transform the health care system in Alberta but had never floated changes of this magnitude. As part of the system overhaul, Ms. Smith’s government has leaned into the private industry.

Just last week, Alberta announced it will expand the use of private surgical facilities to perform thousands of procedures in an attempt to shorten stubborn wait lists. Deals for these chartered facilities are at the centre of allegations of political interference into health contracts that have dogged Ms. Smith’s government for months.

Adriana LaGrange, Alberta’s Minister of Primary and Preventative Health Services, told reporters on Tuesday that she could not speak to specifics of the draft legislation before it is tabled.

She declined to say who the province consulted on the potential legislation but said the United Conservative government remains committed to a publicly funded system.

“We’ll make sure that if you need any type of essential service or essential medical care that that is provided to you and that you will have that at no cost,” said Ms. LaGrange.

During Question Period, Ms. Smith did not directly address the proposed legislation despite questions on it from the Opposition. Instead, she touted the use of private surgical centres as a way to decrease wait lists.

Criticism of the public-private proposal was swift on Tuesday, including from the Alberta New Democratic Party and from physician advocacy groups, such as the Alberta Medical Association. The Canadian Medical Association (CMA) called on Alberta to reconsider the potential legislation.

Family physician Danyaal Raza, an associate professor at the University of Toronto, said the changes as drafted would violate the Canada Health Act, which states doctors cannot charge patients privately for care that is otherwise publicly covered.

“If it goes forward in its current form of violation of the Canada Health Act, that means that the Alberta government is putting at risk funding that Albertans rely on for the public health care system,” said Dr. Raza.

The act is a funding agreement between the federal government and provinces and territories, which sets the conditions that must be followed for these entities to receive the Canada Health Transfer. If provinces or territories fail to meet the criteria, funding can be withheld.

Guillaume Bertrand, director of communications for federal Health Minister Marjorie Michel, would not say if Alberta’s proposed legislation would fly in the face of the federal law. But he said Ottawa “will always protect” the universal health system.

Ms. Michel and Health Canada officials are engaging with their counterparts in Alberta, said Mr. Bertrand, to better understand the components and implications of these proposed changes.

In Quebec, hundreds of doctors already operate clinics where patients are charged out-of-pocket for consultations. Those doctors are not part of the provincial medicare system, as such their practices do not contravene the Canada Health Act.

The federal law also prohibits extra-billing, a practice where doctors who work under medicare charge above the public insurance rates.

Alberta’s draft amendments prohibit extra-billing and also contain clauses that would give the government power to restrict certain services to ensure “adequate provision” of publicly delivered care.

Margot Burnell, president of the CMA, said Quebec is a “cautionary tale” in private health care. Wait times continue to grow for patients, she noted, as more physicians leave the province’s public system.

“Alberta’s private care plans may similarly weaken an already challenged public health system,” said Dr. Burnell.

She said evidence from around the world clearly shows that health outcomes and access to care worsen when a private system operates in parallel to a public one.

Alberta NDP Leader Naheed Nenshi told reporters on Tuesday that the planned changes amount to “American-style medicine” that will make care more expensive and harder to access.

“For those who can’t afford to pay, their wait times will get even longer,” said Mr. Nenshi, adding that these problems are acute in rural and smaller communities, which are the heart of Ms. Smith’s conservative base.

He also took aim at the fact Ms. Smith did not campaign on such sweeping changes. If the legislation moves forward, he said Ms. Smith should dissolve the legislature and call an election on the issue of privatization of health care.

With a report from Tu Thanh Ha in Toronto