Alberta’s Bill 11 could pave the way for a two-tier health-care system that mimics the one found in the U.S., say the authors of a new report that was jointly produced by the Canadian Centre for Policy Alternatives and the Parkland Institute.

The Health Statutes Amendment Act, 2025 (No. 2), also known as Bill 11, came into force on Dec 18. 

The provincial government has said the legislation looks to make way for a “dual practice” model in Alberta, allowing doctors to work in both the public and private system.

The government has argued this will relieve pressure on the public system, potentially decreasing wait times.

A range of opinions have been voiced about the legislation and how a dual practice model could play out. 

The CCPA and Parkland Institute released their report — “The end of Canadian medicare? Alberta legislation opens the door to U.S. health care” — on Tuesday. 

“This is unlike what exists in any other part of the country. It’s a first in Canada,” said Andrew Longhurst, senior researcher with the CCPA, who co-authored the report with Rebecca Graff-McRae, a research manager for the Parkland Institute at the University of Alberta. 

“What it does is it basically undermines the single-payer nature of public health care in Alberta, and it has huge ramifications for the rest of the country.” 

The report argues that Bill 11 establishes two-tier health care by funnelling medical professionals such as physicians, nurses and anaesthesiologists toward private practices such as chartered surgical facilities (CSF). 

In a statement to CBC News in January, Hospital and Surgical Health Services Minister Matt Jones noted about 20 per cent of Alberta surgeries take place in CSFs.

Two-tier health care is defined in the report as a system that provides faster access to those with the ability to pay privately, and longer public wait times for those who are unable to pay for queue-jumping.

Longhurst said he believes Bill 11 may be violating multiple sections of the Canada Health Act, which could have ramifications for Alberta as the province’s health budget relies on funding from the federal government through the Canada Health Transfer.

When asked about the bill, a spokesperson for Health Canada told CBC News on Tuesday that the federal government “will always protect the Canada Health Act and Canada’s universal health-care system.”

Emmanuelle Ducharme, spokesperson for federal Health Minister Marjorie Michel, noted the federal government has a collaborative approach with all provinces and territories to ensure all Canadians continue to have equitable access to medically necessary care based on their medical needs, not their ability to pay.

“Health Canada officials are engaging Alberta officials to better understand the various components and implications of these proposed changes,” Ducharme said.

“Minister Michel is also having regular conversations with her Alberta counterparts.”

Different researchers have different perspectives on the value of implementing a dual health-care system. In a news release issued in November, the Alberta government said the dual practice model is “widely used in countries with top-performing health systems, including Denmark, the Netherlands, United Kingdom, France, Germany, Spain and Australia.”

Emmanuelle Faubert, an economist at the public policy think tank MEI, said she also believes the merits of a dual model are evident in some European countries, and she welcomes the idea of a dual model if adequate safeguards are in place.

“What we need to do is not put full breaks,” she said. 

“We need to encourage it and have proper guardrails around it to make sure that it works as best as it can and that it brings the benefits that it can bring.” 

Faubert noted these benefits could include physicians having more time with patients, and patients experiencing shorter wait times. 

Longhurst said he believes it is difficult to compare existing systems to what Alberta is proposing because the circumstances are too different.

“One of the things that is also very distinct from many other jurisdictions outside of Canada is they (European countries) tend to have upwards of double the number of physicians on a per capita basis,” he said. 

“We’re in a context now where we can’t even staff for emergency departments and our clinics. So to imagine that we’re going to have a two-tier system where we’re magically going to have the workforce required is just that, it’s magical thinking.” 

When asked about the report, Maddison McKee, a spokesperson for Alberta’s Ministry of Primary and Preventative Health Services, dismissed its findings.

“The so-called ‘report’ is a collection of NDP talking points, starting with its title — a phrase used by (former) NDP leader Rachel Notley … to attack contracting surgeries to CSFs, despite the fact that the NDP government contracted the same surgeries,” McKee said. 

“We remain committed to building a stronger publicly funded health system with better access to surgeries and other care, and upholding Alberta’s Public Health Care Guarantee, ensuring that no Albertan will ever have to pay out of pocket to see their family doctor or receive the medical treatment they need.” 

Longhurst said his concerns about the possibility of a two-tier health-care system emerging extend beyond Alberta, noting his concern with recent comments made by Premier Scott Moe about the state of health care in Saskatchewan.

“The concern is that if other provinces look to create a private health insurance market with private payment for basic health-care services, it entirely unravels public health care in this country,” Longhurst said.