The Alberta government has defended its plan to introduce a public-private health care model for doctors.Jeff McIntosh/The Canadian Press
For decades now, federal and provincial governments in Canada have fought against efforts to see a public-private model of health care take root. No more.
The Alberta government is planning to allow a hybrid system to operate, one in which physicians can work in both a private and public setting. To this point, provinces even imagining such a scenario have been discouraged by a federal government that has warned that such an undertaking would be in direct violation of the Canada Health Act.
So far, there have been no discouraging sounds emanating from Ottawa. Hopefully, Prime Minister Mark Carney is prepared to give this concept a try. Can it possibly be worse than the health care system that exists in this country today? We’re about to find out.
“The changes being considered by Alberta are a good first step,” said Dr. Brian Day, the country’s leading public-private health care proponent, in an e-mail. “Data worldwide shows our system, despite being one of the world’s most expensive, is among the worst in terms of patient access and outcomes.”
Dr. Day has been fighting the good fight for public-private health care for decades. He lost a highly publicized case at the B.C. Supreme Court in 2020, with the judge in the case concluding that the province’s law prohibiting private payment for medical services was not a violation of a patient’s Charter rights. When the Supreme Court of Canada refused to hear an appeal of the matter in 2023, it ended Dr. Day’s 14-year fight to see a hybrid model thrive in this country.
Alberta defends public-private health care model as experts say it could violate Canada Health Act
As has been well documented, public-private health care systems exist around the world, including in countries with some of the best health outcomes. But many doctors here have fought hard for the status quo, arguing that allowing any type of private health care would lead to a U.S.-styled system that favours the rich – even though that has not been the case elsewhere in the world where a hybrid system exists.
The anti-private health care critics also ignore the fact that private, for-profit health care clinics are booming in Canada. Because of our bizarre laws, someone from Alberta can get knee surgery at Dr. Day’s private Vancouver clinic, but someone from B.C. can’t. How does that possibly make any sense?
Provincial governments across the country are also using these same private clinics to reduce waitlists for various procedures, such as hip replacements.
The reality is, the health care system in Canada is a mess. The primary problem is a lack of family doctors, which is the result of government policy from years ago that grossly restricted the number of medical graduates from Canadian universities. We are paying the price for that short-sightedness today.
Family doctors are not the ones who are expected to take advantage of the public-private model Alberta is about to introduce. A few might toggle back and forth between the two, but it will largely be surgeons. They will now have operating-room time open to them that doesn’t exist in public hospitals. People willing to pay to get treated for a problem sooner than they would otherwise in the public system will be able to do so. This means those in the public queue move further up the list.
In theory, at least.
Critics of the plan will point to studies that have concluded the public-private model is not in a patient’s best interests. A recent one out of Britain found that public hospitals in Scotland – which does not allow private health care – were more egalitarian and effective at reducing surgical wait times than the private clinics and hospitals contracted out by England’s health care system. Why? Ostensibly because in England, valuable resources were sucked away from the public system, to its detriment.
Opinion: Allowing doctors to practise in both public and private systems solves what exactly?
Perhaps that was the case. But proponents of a public-private model like the one Alberta is about to test will point to countries where a hybrid system exists and produces better health outcomes than Canada – Denmark, Sweden and Australia among them.
It’s time we saw what happens when such a system is allowed to exist. It will either confirm the worst-case scenarios imagined by opponents or demonstrate that their fear-mongering was just that.
“I believe the next step should be to permit private insurance,” says Dr. Day. “We live in the only country on Earth that outlaws that option. Government data shows low-income Canadians suffer from the poorest access and worst outcomes. We can emulate better performing countries such as Switzerland and the Netherlands, by subsidizing their insurance while allowing wealthier Canadians to pay their own premiums.”
Alberta deserves credit for at least giving the public-private model a chance. Hopefully, it can improve a system that is slowly crumbling under the weight of demand.
Editor’s note: A previous version of this article incorrectly stated that the Supreme Court of Canada upheld the B.C. Supreme Court’s ruling in a case brought by Dr. Brian Day, a proponent of public-private health care. The Supreme Court of Canada refused to hear an appeal in 2023.