Mixed practice respects the Canada Health Act, reminds the MEI
- In addition to Alberta, four other Canadian provinces authorize mixed practice.
Montreal, September 14, 2026 – As Alberta begins to introduce mixed practice into its healthcare system, the MEI points out once again that this model does respect the Canada Health Act.
“Mixed practice has not developed everywhere that it is permitted, for a number of reasons, but it is important to remember that there are already four provinces that authorize it,” says Renaud Brossard, vice president of Communications at the MEI. “Indeed, it is not so much the Canada Health Act that obstructs its development and deployment, but rather a series of provincial laws and administrative practices.”
Last fall, Alberta adopted the Health Statutes Amendment Act, which allows doctors to practise in both the public and private sectors. They must, however, continue to provide a minimum number of hours of care in the public system.
Also, some of Quebec’s main political parties have mentioned that they were considering adopting mixed practice in the province.
By removing the prohibition on mixed practice in their provincial laws, Quebec and Alberta would join Manitoba, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador.
“What the Canada Health Act circumscribes is much more limited than certain defenders of the status quo like to claim,” says Renaud Brossard. “Unfortunately, over time, too many people have tried to make this law mean anything and everything.”
Basing itself on a legal opinion from the firm of Trudel & Johnson—which had co-represented Mr. George Zeliotis in the Chaoulli vs. Quebec case—an Economic Note published by the MEI in 2003 points out that mixed practice respects the Canada Health Act.
Insofar as the services delivered by physicians in mixed practice are uncovered and entirely paid for by patients or their insurers when they are provided in a private clinic, but are still provided free of charge in public facilities, the introduction of mixed practice respects the conditions of the Canada Health Act.
By continuing to fully finance publicly covered services and by ensuring that the public system remains universal and accessible to all, a provincial government fulfills its obligations under the Canada Health Act to receive full federal funding.
When it comes to universality, the wording of the law stipulates that “In order to satisfy the criterion respecting universality, the health care insurance plan of a province must entitle one hundred per cent of the insured persons of the province to the insured health services provided for by the plan on uniform terms and conditions.”
Over twenty years later, the main provisions of the Canada Health Act remain unchanged, and therefore the introduction of mixed practice respects this framework.
“People are reading into Canadian law prohibitions that do not exist,” says Mr. Brossard. “It is the combining of public and private funding that the law essentially aims to prevent, which would for instance allow patients to pay to get publicly funded care more quickly.
“It concerns overbilling and copayments, not whether a physician can work in both the public and private systems.”
Mixed practice: A proven model in many countries
According to data from the Commonwealth Fund, Canada’s healthcare systems are ranked seventh among those of 11 comparable countries in terms of performance.
Ahead of us are Australia, the Netherlands, the United Kingdom, New Zealand, France, and Sweden. Of those six countries, not one prohibits mixed practice.
A Danish study found no statistically significant difference in the number of hours worked in the public system by doctors in mixed practice versus those working exclusively in the public system.
However, physicians in mixed practice add on average 5.2 extra hours a week in private care facilities, thereby increasing overall treatment capacity.
“Instead of resorting to scare tactics, Ottawa should ask itself why Canadian health care struggles so much to meet patients’ needs,” concludes Mr. Brossard. “Mixed practice is in full compliance with the Canada Health Act, and would help provide more care, more quickly, to more patients.”
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The MEI is an independent public policy think tank with offices in Montreal, Ottawa, and Calgary. Through its publications, media appearances, and advisory services to policymakers, the MEI stimulates public policy debate and reforms based on sound economics and entrepreneurship.
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Renaud Brossard
Vice President, Communications
Cell: 514-743-2883