Improving Canadian Patients’ Access to Care: The Role of Duplicate Private Health Insurance

Economic Note showing how countries like Australia and Denmark improve access to health care by allowing for the private coverage of services that are already included in the public plan

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Allowing private health insurance for basic care could reduce wait times, expand hospital beds: report (National Post, July 2, 2026)	Interview (in French) with Emmanuelle B. Faubert (Le show du matin, KYK Radio, July 3, 2026)

This Economic Note was prepared by Conrad Eder, Associate Researcher at the MEI, in collaboration with Emmanuelle B. Faubert, Economist at the MEI. The MEI’s Health Policy Series aims to examine the extent to which freedom of choice and entrepreneurship lead to improvements in the quality and efficiency of healthcare services for all patients.

For many, the defining feature of Canada’s healthcare system is waiting: waiting weeks for a specialist, waiting months for surgery, and sometimes waiting years to obtain a family doctor. These challenges in accessing care are persistent and worsening, and they have raised serious questions about whether the current healthcare model is well-suited to deliver on its objective.

This debate, however, often stalls due to a tendency to conflate the objective of universality (whereby all residents have coverage for a defined basket of services) with the single-payer model (whereby one public insurer pays for all covered services). Such confusion has constrained policy discussions about which financing model—within a universal healthcare system—most effectively provides patients with timely access to care.

Most high-performing universal healthcare systems are not strictly single-payer.

Most high-performing universal healthcare systems are not strictly single-payer. Countries including Australia and Denmark combine public coverage with private duplicate insurance, allowing for the coverage of services that are already included in the public plan. They also let physicians engage in mixed practice so that they can offer services to both publicly and privately insured patients.

Canada can do the same. By removing prohibitions on duplicate private health insurance and mixed practice—restrictions that have not produced superior outcomes—Canada can catalyze private investment to increase healthcare system capacity and expand access to expedited private care pathways, and in doing so, relieve pressure on the public system while improving access to care for all patients.

Access Challenges Persist Despite Record Healthcare Spending

Canada’s healthcare system is characterized by inadequate capacity relative to patient demand, as evidenced by the 1.4 million procedures that Canadians were still waiting for as of 2025.(1) Fully 17% of them do not have a primary care provider, while even among those who do, 74% were unable to obtain a same- or next-day appointment.(2) The median wait time from referral to treatment was 28.6 weeks in 2025,(3) and during that year, 23,746 patients died while waiting for care.(4)

Public spending alone has not resolved these challenges. Despite annual increases of 6.5% in 2023, 6.6% in 2024, and 3.9% in 2025,(5) additional government funding has not translated into expanded capacity and improvements in access to care. Canada already has one of the highest ratios of health expenditure to GDP in the OECD at 12.7%,(6) spending an estimated $399 billion, or $9,626 per Canadian, in 2025(7) (see Figure 1).

Unlocking New Capacity Through Private Investment

Duplicate private health insurance provides full or partial coverage of services already included under a public plan, such as examinations, procedures, and surgeries. These services are often (though not exclusively) delivered in private hospitals or clinics by a range of healthcare providers. Those with such coverage benefit from faster access to care and greater choice of provider. However, the benefits extend beyond individual policyholders as broader system-wide effects can improve access to care for all patients.

A duplicate insurance market, in which coverage is both widely available and broadly affordable, creates the conditions for private providers to contribute meaningfully to overall healthcare system capacity. By pooling risk and charging predictable premiums, private insurance effectively lowers the cost of private care, thus significantly expanding the patient population that can afford it. In turn, this expands the customer base for private clinics, surgical centres, and diagnostic facilities, making it commercially viable to privately build, staff, and equip infrastructure that would not otherwise exist.

Competition reinforces these effects as insurers vying for customers are motivated to offer more customizable insurance products at a range of price points. Meanwhile, providers competing for patients, being judged on quality and timeliness, are incentivized to innovate in the provision, organization, and delivery of care. Over time, successful innovations spearheaded in the private sector can spread to the public system, generating broader system-wide capacity gains that benefit all patients.(8)

The median wait time from referral to treatment was 28.6 weeks in 2025.

Mixed practice strengthens this dynamic by promoting the transfer of knowledge and best practices between sectors, as clinicians work across public and private settings. It also empowers clinicians to meet privately insured demand for private care by contributing additional clinical hours beyond their public commitments, as opposed to leaving the public system altogether in order to do so.(9) Furthermore, allowing physicians to bill the public plan and private payers concurrently would increase the number willing to accept duplicate insurance as payment and thereby expand the number of facilities (both public and private) where patients could use their coverage to access care. This would make private insurance more widely usable and help create the conditions for a viable private delivery market to emerge.(10)

As private facilities deliver privately financed care, they divert and absorb patient demand that would otherwise congest public infrastructure,(11) thus helping to reduce wait times in the public system. These facilities can also serve as a safety valve. When demand from publicly insured patients exceeds public system capacity, governments can contract with private facilities, leveraging privately financed infrastructure to deliver care to publicly insured patients more quickly than would otherwise be possible.

Private infrastructure expansion also has important implications for Canada’s health human resources pipeline. Despite persistent physician shortages, governments constrain medical school enrolment in part because residency positions, required for licensure, are limited by the capacity of clinical settings to host and supervise them. As privately financed facilities grow in number, they can create additional training sites,(12) effectively raising the ceiling on residency placements and medical school admissions, contributing to a larger and more sustainable healthcare workforce over time.

International Evidence

Australia
Australia offers a compelling example of how universal, tax-funded healthcare can coexist with a robust private system of healthcare finance and delivery. Alongside public insurance (Medicare) coverage for hospital care, physician services, and specialist consultations, many Australians choose to purchase duplicate private insurance, known as hospital cover.(13) Approximately 45% of Australians held such coverage in 2025.(14) As of 2026, for an individual, monthly premiums range from AU$88 to AU$306 per month (C$84 to C$293).(15)

The private sector plays a significant role in expanding system capacity. As of 2024, Australia’s 647 private hospitals collectively provided over 36,000 hospital beds,(16) helping to supplement public resources (see Figure 2). That same year, these facilities admitted 5.1 million Australians, accounting for 40% of all hospital admissions(17) while only making up 35% of all hospital beds.(18) With this additional capacity, when wait times in the public system exceed recommended thresholds, governments contract private hospitals to treat publicly insured patients faster.(19)

Notably, the expansion of private insurance in Australia has not substantially increased overall hospital use. Instead, it has diverted patients who would have otherwise been treated in public hospitals into private settings.(20) This shift effectively eases pressure on public infrastructure, contributing to modest reductions in public hospital wait times that have been associated with the expansion of private insurance.(21)

Denmark
Denmark presents a similarly informative model. It also maintains universal, tax-funded coverage for all or part of most medical treatments, alongside a growing duplicate private insurance market. Approximately 32% of Danes(22) hold such coverage, typically through workplace benefits. Plans range from DKK 300 to DKK 600 per month (C$65 to C$129).(23)

While smaller in scale, Denmark’s private sector still adds valuable capacity. As of 2021, 19 private hospitals contributed 354 for-profit and 633 non-profit beds, accounting for close to 7% of hospital beds nationwide.(24) The Danish government leverages this additional capacity by contracting private hospitals to deliver publicly funded care when the public system cannot treat patients within recommended timeframes.(25)

Private insurance lowers the cost of private care, expanding the patient population that can afford it.

The increasing use of private health insurance and private hospitals, along with other reforms including activity-based funding, coincided with a 36.7% reduction in average surgical wait times across Denmark between 2001 and 2011.(26) Duplicate insurance was also found to meaningfully redirect demand away from the public system, as employer-paid health insurance reduced total public hospital use by 10%.(27)

A Path Forward for Canada

Canada, Australia, and Denmark share similar economic and institutional foundations along with a commitment to universal healthcare. A key difference is that while Canada largely prohibits duplicate private insurance and mixed practice, Australia and Denmark use them to expand health system capacity and facilitate timely access to care for all patients.

Canada already has a well-established market for private health insurance, with roughly two-thirds of Canadians holding supplementary private coverage, often through workplace benefits, for services such as prescription drugs, dental care, and vision care. As a result, much of the infrastructure required to support a duplicate private insurance market already exists. Administrative systems, regulatory familiarity, and insurer capacity are essentially in place, leaving government prohibitions as the primary barrier.

Six provinces functionally ban duplicate private health insurance for services already covered under their respective public insurance plan: British Columbia, Alberta, Manitoba, Ontario, Quebec,(28) and Prince Edward Island. The remaining four provinces (New Brunswick, Newfoundland and Labrador, Nova Scotia, and Saskatchewan) do not formally prohibit it. However, no meaningful market for duplicate private insurance or private care has developed due to other regulatory barriers, including restrictions on mixed practice, as well as small population sizes that limit market viability.(29)

These provincial restrictions on duplicate private health insurance go beyond what is required under the Canada Health Act. In addition to removing them, consideration can be given to complementary measures to ensure that the benefits of private insurance and private care are distributed as broadly as possible. This could include open enrolment policies that allow individuals to purchase coverage regardless of health status, or community-rated pricing in which premiums are set uniformly across a population.(30) Targeted premium supports could also be considered.(31)

Canada’s restrictive approach has not delivered the kind of equity it is assumed to guarantee.

At the same time, restrictions on mixed practice should be removed and replaced with clear guardrails to ensure that physicians’ private work supplements their public commitments.(32) With this flexibility in place, clinicians would be in a position to respond to patient demand, leveraging the additional capacity made possible by private infrastructure, and supported by private insurance.

Participation in duplicate private insurance would be voluntary, and public coverage through tax-funded public health insurance plans would remain in place. Removing these prohibitions would allow consumer demand and insurer interest to determine whether and how a duplicate insurance market develops. If uptake proves limited, the legislation would simply have removed an unnecessary restriction on individual choice. If the market develops, as it has in Australia and Denmark, Canadians stand to benefit from a more responsive and robust healthcare system.

Canada’s restrictive approach has not produced the level of access that patients expect, nor has it delivered the kind of equity it is assumed to guarantee. Queue-jumping and preferential access without clinical justification, as documented in provincial health system audits,(33) highlight how status and connections already influence access to care. At the same time, an estimated 105,000 Canadians travelled abroad for medical treatment in 2025,(34) underscoring that those with sufficient means can and do secure timely access to high-quality care elsewhere.

Allowing duplicate insurance to cover privately delivered medically necessary services, far from creating inequity, would formalize and broaden access to timely care while facilitating investment in private infrastructure, thereby increasing overall healthcare system capacity. The primary beneficiaries would not be the wealthy or well-connected, who already have access to alternatives both domestically and abroad, but rather the many Canadians who currently face months, if not years, on waiting lists with no recourse and no alternative.