The end of Canadian medicare? Alberta legislation opens the door to U.S. health care
- Rebecca Graff-McRae
- 1 hour ago
- 2 min read
February 3, 2026
Written by: Andrew Longhurst and Rebecca Graff-McRae
The end of Canadian medicare? was created in collaboration with the Parkland Institute and is also available at parklandinstitute.ca
On December 18, 2025, Alberta became the first province to legislate two-tier health care and private health insurance for medically necessary services. Bill 11 establishes two-tier health care, which is defined 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.
This is the latest intervention in the health care system by Danielle Smith’s United Conservative government, following a dramatic restructuring of the provincial health authority, transfer of health care facilities’ ownership, expansion of for-profit surgical outsourcing, and complex changes to the hospital funding model that create perverse incentives.
Here are 11 things you should know about Alberta’s new two-tier health care system—and why it matters for the rest of Canada.
1. Bill 11 legislates two-tier health care in Alberta—the first in Canada
Under Bill 11 (the Health Statutes Amendment Act), Alberta is the first province to allow “dual practice” where doctors can work simultaneously in both the public system and the private-pay market. Bill 11 amends the Alberta Health Care Insurance Act by creating a new category of doctor or surgeon: “flexibly participating physicians” can charge patients privately while simultaneously maintaining their ability to bill Alberta’s public insurance plan. No other province in Canada allows this. Dual practice has been roundly criticized by health policy experts based on the large body of Canadian and international evidence that a two-tier system increases public wait times and creates unequal access based on income.