Premier Smith ended 2025 with a decisive — and divisive — decision to allow physicians to provide private care without sacrificing their public role. This reform brings doctors and nurses in-line with teachers who can work in the public system and work privately in their spare time.
The move also improves choice for patients and brings Alberta closer to European universal healthcare systems that perform better. But there’s more work to do.
The reality is immediate relief will come to those who both need and can afford it. This is not just the affluent, but for middle class patients like Tracy Skinner from Sylvan Lake who had to fly to Mexico for back surgery and Jackie Herrera from Gull Lake who had to fly to Germany for neck surgery. By making changes that will allow patients like Tracy and Jackie to pay for treatment in Alberta, instead of having to leave the province, the Smith government will help reduce the burden on the public system. But, with over half a million patients waiting for treatment, doing so will take time.
So, what else can Smith do to ensure a robust public healthcare system that is ready for reform?
First, the provincial government must clarify and communicate the specific guardrails it intends to put in place so we don’t see an exodus of staff from the government’s healthcare system to non-government clinics. Such protections are an important feature in many (albeit not every) other universal systems.
For example, analysts Krystle Wittevrongel and Conrad Eder examined universal healthcare in Germany, France, and the UK and found that they all require dual-practice physicians to prioritize public sector responsibilities. For example, dual-practice physicians in Germany must commit to working at least 25 hours for the public system before they can provide private care. In France, the requirement is five “half-days” and private activity is capped at 20% of physicians’ public activity.
While the Smith government has prudently entrusted the Minister of Health with the authority to employ similar guardrails, the specifics will be important to ensure Smith’s reforms will reinforce, rather than weaken, the public system.
Next, the Premier should make good on her promise to change the way all hospitals and clinics — public or private — are funded. Currently, Alberta and most other provinces fund hospitals by essentially giving them a large cheque at the beginning of the year and wishing them good luck. This “global budget” approach is opaque, outdated, and does not incentivize care. By contrast, most other universal healthcare countries (and even some Canadian provinces) have shifted to a more modern approach. Activity-based funding (ABF) provides hospitals with funding every time they help a patient. While the Premier signalled a shift towards this common-sense approach, it is yet to be implemented.
The switch to ABF may also need to be accompanied by a temporary increase in the amount of healthcare funding to accommodate the expected spike in surgical activity. A system-wide change of this magnitude might very well need an injection of funds to kick-start things in the right direction. The reality is empirical evidence suggests the introduction of ABF leads to lower cost per procedure, but potential higher overall costs — at least in the initial years — due to the increased volume of care delivered.
Finally, provincial health agencies must resume tracking the number of patients who die while waiting for care. Alberta is the only province in Canada that does not currently track or disclose any data of this nature, although SecondStreet.org was able to obtain at least incomplete data between 2019-23. Tracking this data is in the Premier’s own interests to gauge the performance of her proposed reforms. It also helps improve accountability in the system.
On the whole, Alberta’s government is moving in the right direction on healthcare. Time will tell how well the government implements the reforms it announced, but the status quo should not be an option.
Bacchus Barua is the Research Director at SecondStreet.org, a Canadian think tank.
This column was originally published in The Western Standard on February 9, 2025.
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