The controversy behind Bill 11 — Alberta’s move to a dual-practice health system
As Alberta rolls out a new “dual-practice” model for health care — where doctors can switch between billing public and private insurance plans — patients, physicians and politicians across the country are watching. Here’s what you need to know.
Canadian Medical Association September 1, 2026
| Why is Bill 11 getting so much attention? |
Bill 11, the Health Statutes Amendment Act, 2025 (No.2), creates a category of “flexibly participating physicians” that doesn’t exist anywhere else in Canada. Instead of choosing to fully opt into or out of the public health system, doctors in Alberta can decide on a case-by-case basis whether to bill the province for their services or provide private-pay care.
Related legislation, Bill 29, also allows Albertans to bypass a family doctor and directly purchase private “preventative health” tests including MRIs and CT scans.
Many governments in Canada are looking at private options to reduce wait times. The question is whether they increase system capacity or simply create a two-tier system. Those against Bill 11 suggest it promotes queue-jumping and will open the door for private insurance companies to profit off patients in Canada.
| What does dual practice mean for doctors? |
Not all doctors can participate in dual practice. Bill 11 covers specialists in orthopedics, cataract surgery, gynecology, ophthalmology, select ENT procedures, plastic surgery and dermatology. Family physicians aren’t eligible, except those with a subspecialty in anaesthesia or surgical assistance.
Doctors approved for dual practice will be required to provide a minimum number of hours or a targeted number of procedures in the public health system, based on medical specialty and location.
The benefit to participating doctors is that there is currently no cap on how much they can earn from private-pay services. However, follow-up care from these services, as well as diagnostics paid for by patients out of pocket, could increase workloads in the public system.
| What does dual practice mean for patients? |
In 2025, the median wait time in Alberta for orthopedic procedures was 58.8 weeks from referral to a specialist to surgery. Those who can pay for services like these may be able to get faster care, and the government argues that this will also alleviate pressure on the resource-strapped public system.
Many health advocates disagree; they say patients stand to lose in a dual-practice system because overall public wait times will worsen, and patients in vulnerable positions may feel pressured to pay out of pocket for a service in order to receive care.
| What has the CMA said about Bill 11? |
The CMA has joined other health care organizations in expressing deep concerns about Bill 11, calling for a federal review of its implications. These include how dual practice impacts access based on patient need rather than ability to pay, and how it affects accountability and continuity of care.
Recent evidence from the CMAJ suggests health system efficiency increases in proportion to the public share of financing. In addition, countries with more private financing report lower universal coverage — fewer services are covered for everyone.
| How does Bill 11 impact the rest of Canada? |
Federal Health Minister Marjorie Michel recently said she had concerns about how this legislation would co-exist with the Canada Health Act, which explicitly lays out Canada’s commitment to “universality” and “accessibility.”
This legislation, and how it’s used, could have implications for other jurisdictions in the future, eroding universal, equitable access to health care.
Source Canadian Medical Association
Also see
Learn more about public and private health care in Canada CMA
Alberta’s Dual-Practice Model: Two-Tiered Healthcare? Medscape
Alberta Moots Surgery Voucher System to Shorten Wait Times Medscape
