Conflict brewing over Alberta’s dual practice legislation

A national advocacy group is calling on the federal health minister to denounce Bill 11 while others say reform is needed. Nicole Weisberg reports.

A national advocacy organization in support of universal public health care is calling on the federal government to condemn the Alberta UCP government’s dual practice legislation.

Bill 11, the Health Statutes Amendment Act, was passed in December and allows doctors to work in both the public and private systems.

“Nowhere in Canada does it allow for dual practice, so-called dual practice, or people in both streams. In Quebec, they have it set up that you can opt out of the public system and go into the private system but nobody that’s working in both,” Canadian Health Coalition Chair Jason MacLean told CTV News Edmonton in a virtual interview.

The group commissioned a legal opinion to determine if Bill 11 violates the Canada Health Act earlier this spring.

The federal legislation lays out the primary objective of health policy in Canada and outlines principles the provinces must adhere to to receive health transfer payments.

Lawyer Emma Phillips told CTV News Edmonton Bill 11 is “fundamentally inconsistent” with the act’s requirement of ensuring reasonable access to medically necessary services without financial or other barriers.

“Even if the legislation says we’re not going to allow dual practice in cancer care or emergency room services, that doesn’t address the problem that for all other forms of medical care, Albertans are now going to be subject to a two-tier system,” said Phillips with Goldblatt Partners LPP.

Phillips said interpretation letters that federal ministers of health have written over decades confirm her stance.

She also said the legislation creates conflict of interest issues at the expense of the publicly funded system.

“There is inevitably a financial incentive for physicians to allocate more of their time to the private-pay stream where compensation is greater,” she wrote.

Push for feds to get involved

The Canadian Health Coalition is using the legal opinion to put pressure on the federal government to take action against Bill 11.

Its members met with federal Minister of Health Marjorie Michel ahead of her meeting with Alberta’s Surgical and Hospital Health Services Minister Adriana LaGrange earlier this month.

“We urged the minister to speak against it. The minister said to us that they’re waiting for the regulations,” said MacLean.

The federal and provincial ministries would not provide details about the June 3 meeting, telling CTV News Edmonton the two discussed “matters of mutual interest.”

Phillips believes it is incumbent upon Canada’s health minister to uphold federal legislation.

“The federal government is accountable to Albertans and to the rest of Canada to ensure that the principles of the Canada Health Act, which we across the country hold very dear, that those principles are upheld and are enforced,” she said.

The coalition said the feds can cut off health transfer payments to Alberta if it doesn’t adhere to the act.

The province is receiving more than $7 billion this fiscal year.

A statement from the provincial ministry said dual practice does not violate the act since it “does not prohibit private practice operating outside the publicly insured system.”

Regulations being developed

The ministry also said it is developing regulations to implement dual practice responsibly “informed by evidence and engagement with a range of stakeholders.”

The Alberta Medical Association (AMA) recently provided a report to the province with 70 proposed safeguards for dual practice.

“If the government is going to go down this road, we do think that they need to be made aware of what the literature shows,” AMA President Brian Wirzba told CTV News Edmonton.

The document states a dual practice model must be tightly regulated, public interest driven and data transparent.

“One overriding committee to sort of look at the outcomes, monitor the metrics, make sure that we’re actually moving things in the right direction is essential,” Wirzba said.

He cautioned there is a “very real risk” of pulling skilled physicians out of the public system.

“Particularly, we’re worried about loss of anesthesiology within hospital systems, particularly for emergent and urgent surgeries,” he explained.

There has been a shortage of anaesthesiologists across Canada for years.

‘Something has to give’: private practice pioneer

B.C. orthopedic surgeon Dr. Brian Day supports the Alberta government’s venture into expanding private care.

“There’s evidence out there that having a little bit of competition forces the public system to perform better,” Day told CTV News Edmonton in a virtual interview.

Day opened the Cambie Surgery Centre in Vancouver 30 years ago.

It provides services to groups such as WCB-covered workers, federal inmates and people willing to pay out of pocket from out of province.

“If you want to get out of a waiting list, you just have to cross the border,” said Day.

“A number of months ago I was in Vancouver operating on five Albertans and a surgeon in Alberta was operating on six British Columbians the same day. It could be a Monty Python episode.”

The doctor spent years trying to change laws to make it legal for the average British Columbian to access his hospital.

He argued patients have a constitutional right to pay for private care when waits in the public system are too long.

The B.C. Supreme Court ruled against Day in 2020, stating there is “considerable evidence and literature that, where there is duplicative private health care, physicians reduce their time and efforts in the public system,” leading to increased waits.

The ruling was later upheld by the B.C. Appeal Court and would not be heard by the Supreme Court of Canada.

Day still believes there’s value in privatized care including private insurance covering medically necessary services.

“Every other country, including the communist countries, have that,” he said.

Day told CTV News Edmonton “something has to give” as more Canadians get older and live longer.

“The system is going bankrupt,” he said.