The emergency entrance of the Northern Lights regional health centre in Fort McMurray, Alta., on April 14.Jeff McIntosh/The Canadian Press
Alberta’s public-private health care model directly contradicts the requirements and principles of the Canada Health Act, law firm Goldblatt Partners says in a new legal opinion.
The opinion, to be released Tuesday, was commissioned by the Canadian Health Coalition, an advocacy group focused on the preservation of universal health care.
Goldblatt’s Emma Phillips, who is recognized as a leading practitioner in labour and employment law, concluded Alberta breaches the federal legislation “by explicitly enabling differential access to medically necessary care based on ability to pay in the private market.”
Alberta’s Health Statutes Amendment Act, 2025 (No. 2), also known as Bill 11, passed into law in December. It will allow doctors to work simultaneously in the public and private health care systems, something no other Canadian province permits. The dual-practice model, which is focused on surgeons, is expected to take effect later this year.
Ms. Phillips, in her legal opinion, said Alberta’s law contravenes multiple conditions of the Canada Health Act, which provinces must fulfill to be eligible for federal cash transfer payments. These payments should be deducted, she said, if Alberta forges ahead as planned.
“Alberta’s Bill 11, I think, very clearly violates both the letter and the spirit of the Canada Health Act,” she said in an interview.
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This includes requirements that all medically required services are publicly insured (Section 9), there is “reasonable access” to insured services without financial barriers (Section 12) and people are entitled to them on “uniform terms and conditions” (Section 10).
Additionally, she said, Bill 11 violates prohibitions against user fees and extra billing (sections 18 and 19), which protect patients against out-of-pocket charges for services that are covered by provincial health plans.
Ms. Phillips observed that the federal government has consistently and formally taken the position, since the Canada Health Act came into effect in 1984, that medically necessary services must be provided on the basis of need, not the ability to pay.
Ottawa has clearly argued, she said, that a dual model will create “queue jumping” and shift physicians and other resources out of the public sector. It also has argued it will incentivize physicians to move patients into the private sphere, lengthen public wait times and could result in poor health outcomes for those who cannot afford to pay out of pocket.
Alberta has faced widespread criticism over its dual-practice model. In March, more than 20 national and provincial medical and labour organizations, including the Canadian Health Coalition, issued a joint letter calling on the federal government to take action to uphold the Canada Health Act.
Premier Danielle Smith’s government has argued that the hybrid model will decrease wait-lists for surgeries and attract more physicians to the province. Alberta has said safeguards will be in place, such as requiring a minimum number of hours worked in the public system.
Alberta plans to allow doctors to deliver public and private services
But any safeguards are “no response to the explicit failure of the dual practice provisions, on their face, to respect the requirements and protections of the Canada Health Act,” Ms. Phillips argued in the opinion dated April 30.
Another major component of the legal opinion is the landmark Cambie case in British Columbia. Brian Day, chief executive of the for-profit Cambie Surgeries Corp., sought to overturn provisions that prohibited patients from paying for faster access to medically necessary care.
The 14-year-long legal battle concluded in 2023 after the Supreme Court of Canada declined Mr. Day’s final chance at appeal. B.C. Supreme Court Justice John Steeves dismissed the challenge in 2020, writing in an 880-page judgment that provincial medicare does not violate the Charter rights of patients who want to pay for private care because of long wait times.
The federal government intervened in this case to defend B.C.’s restrictions on dual practice.
In 2015, an Alberta court struck down another challenge that attempted to overturn the province’s ban on private health insurance. The Allen v. Alberta case recognized “dual practice is inconsistent with the requirements and criteria of the Canada Health Act,” Ms. Phillips said, adding that it underlines her conclusion about Bill 11.
She said she hopes the new opinion pushes the federal government to take a firm position and defend universal health coverage in Canada.
“If there are no financial consequences for Alberta, the business and financial pressures on other governments to follow suit is going to be very hard to resist,” she said.