Reform moves Alberta toward more successful universal health care

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Earlier this month, Premier Smith’s reform — that allows some doctors to provide private services for Alberta patients — came into effect, with hundreds of doctors expressing interest. Despite rules that require these doctors to maintain their work in the government system, opponents of the reform claim it will produce a worse health-care experience for Albertans who can’t pay for private care.

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But in reality, this new approach can expand the total volume of available services, drive better performance in the government system through competition, and ultimately improve health care for all patients.

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Let’s start with the claim that allowing patients to pay for their own care privately will divert health-care staff to the private system and reduce the capacity to treat patients in government queues. This claim assumes physicians currently provide as much care as possible via the government system and any additional private care will take away from this time. This is not true.

Waiting for access

Here’s why. While Alberta has fewer physicians than other universal health-care countries, many of them spend a good amount of their time waiting for access to health-care resources and operating room time in the government system. Canada has also pushed new physicians to other countries because of a lack of full-time work. By allowing Albertans to pay underutilized physicians, the government will help increase the amount of total care available and give physicians a reason to stay in Alberta, without impacting their ability to provide publicly-funded care.

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Also, a recent analysis found 40 nurses under age 35 left the workforce for every 100 that entered the workforce in 2023 (the latest year of available data), while surveys show many nurses are unhappy with their working conditions. Some of these nurses could be enticed back into providing health care (or defer retirements) by more flexible and accommodating employment arrangements in private facilities.

Opponents of the Smith reforms also argue that allowing patients to pay for their own health care is not compatible with a universal health-care system. But in reality, out of 31 high-income countries with universal health care, Canada is the only country that does not have a private option for patients alongside the universal system. The overwhelming majority of these countries also allow physicians to serve both the private and government systems with rules to ensure universal access remains a priority, just like Alberta is now doing.

Yes, Alberta’s reform is unique in Canada, but that’s because Canada is unique among universal health-care countries by prohibiting privately-purchased health care. Alberta’s reforms are not unique internationally, and, in fact, help Alberta move closer to the policy approach of more successful universal health-care countries that generally boast greater access to doctors and medical technologies (e.g. MRI machines).

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Not getting what we pay for

Finally, while Albertans (and Canadians) spend more on health care than people in just about any other universal health-care country, they endure some of the longest wait times for care in the developed world. Other countries have much shorter waits — often for fewer health-care dollars — in part because a private alternative increases the supply of services, removes patients from the government queue, and puts pressure on the government system to perform better.

The health-care sky is not falling in Alberta. The government health-care system will not only be unharmed by a private alternative but will likely improve through the increased capacity and competition created by a private option for patients and their doctors.

Nadeem Esmail and Mackenzie Moir are analysts at the Fraser Institute.

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