Canada’s health-care crisis needs innovation, not ideology

Canadians are used to waiting for health care. We wait in emergency rooms, in queues for surgery, and on lists for a family doctor.

Despite being among the world’s biggest spenders on health care, Canada consistently underperforms peer countries on access and equity measures. Patients leave emergency departments without treatment, surgical wait times stretch on for months if not years, and too many report unmet healthcare needs.

Canadians want change, and patients are running out of time. Fortunately, Alberta has decided to do something about it.

With Bill 11, the province is introducing a mixed practice model allowing physicians to work in both the public and private systems.

Why does this matter to patients stuck waiting for care? Because mixed practice can help address three of our system’s greatest challenges: limited physician capacity, underused infrastructure, and doctor recruitment and retention.

When physicians are allowed to work additional hours beyond their public commitments, total capacity increases, meaning more appointments and more procedures. When doctors can make use of idle operating rooms and diagnostic equipment, we can get more care out of the infrastructure we already have. And when the system offers scope for professional autonomy and supplemental income, it becomes easier to attract and retain physicians.

Critics have nonetheless been quick to cast aspersions, comparing the allowance of mixed practice to “American‑style” health care. That rhetoric may generate headlines, but it does nothing for patients who are already living in fear, having had care delayed or denied thanks to the failing status quo.

At any rate, it makes little sense to fixate on a system that neither aspires to nor achieves universal access, and is widely judged to perform worse than our own in most regards.

By embracing evidence over ideology, Alberta can lead a long‑overdue renewal of a cherished Canadian institution, one that hopefully the rest of Canada will follow.

Whereas the best universal healthcare systems in the world, particularly in Europe, have successfully allowed physicians to blend public and private practice for many years now. Countries such as the United Kingdom, the Netherlands, France, Germany, and Sweden provide concrete examples of what is possible when we look beyond this North American dichotomy.

Our European peers offer better points of comparison because they achieve universal access while outperforming Canada across key metrics, providing us with models from which we are able to learn.

In these universal healthcare systems, mixed practice is a salient feature. Physicians can spend part of their week treating publicly insured patients and part offering privately paid services, sometimes in the same clinical setting, under clear rules that preserve universal access for all.

In Germany, physicians who have contracted with the public insurance system must devote a minimum number of hours per week to publicly insured patients, assuring them access to care. France requires physicians who treat private patients inside public facilities to remit part of their private fees back to the hospital, so the public system is compensated for the use of its infrastructure. And in the United Kingdom, contracts and codes of conduct make it explicit that publicly insured patients take scheduling priority. Alberta can adopt similar measures.

But calibration is key. If eligibility criteria are too narrow, minimum service rules too rigid, or revenue‑sharing formulas too punitive, Alberta risks strangling mixed practice with red tape, thereby preventing it from achieving any significant expansion of capacity across the province.

The good news is that Canada is well positioned to get this right. We have stable institutions, experienced regulators, and decades of European experience upon which to draw in order to successfully implement mixed practice to the benefit of all patients.

Combined with other reforms—duplicate private health insurance, activity‑based hospital funding, and expanded private infrastructure—mixed practice can help unlock even greater capacity.

By embracing evidence over ideology, Alberta can lead a long‑overdue renewal of a cherished Canadian institution, one that hopefully the rest of Canada will follow. Reforming it isn’t a betrayal of Canadian values—it’s how we uphold them.

Conrad Eder est chercheur associé à l’IEDM et auteur de « Faire profiter les patients de l’Alberta des avantages de la pratique mixte: les leçons de l’Europe ». Il signe ce texte à titre personnel.