Alberta separation could worsen rural doctor shortages, lengthen wait times and accelerate the shift toward private-pay care

We’d bet that when most Albertans think about health care, they don’t think about the Canada Health Act.

What they do think about is whether they can find a family doctor in their area. Whether their closest emergency room is open. Some unlucky souls wonder whether they’ll get a hip replacement before the pain becomes unbearable.

And now, with private for-pay surgeries starting, Albertans are right to wonder whether they’ll have to pay to receive the surgical care they need in a timely fashion.

That’s why health care needs to be front and centre in any discussion about Alberta separation. Let’s be clear: separation would create enormous uncertainty for a health-care system that desperately needs stability.

Health care is top of mind for many. In coffee shops and our own inboxes, we hear concerns that if Alberta starts incurring the costs of actually running a country (military, passports, etc.), that means less funding for and less focus on health care.

Rural Albertans understand better than most that health-care access is fragile. They’ve lived through temporary ER closures, physician shortages, long drives for specialist care, and ambulance transfers to larger centres. They have more to lose if access gets worse.

Which brings us back to the Canada Health Act. Remember, without the protections of the act, Alberta will be free to move faster toward American-style care where people pay for access to medically necessary services.

This isn’t theoretical. Alberta’s “dual-practice” model began Sept. 1. It lets surgeons work in the public system while also charging patients privately for faster access. Under this arrangement, a patient waiting six to 12 months for a publicly funded hip replacement could instead be offered surgery within weeks, if they can come up with roughly $30,000.

And surgery is just the beginning. Imagine your local doctor offering quicker access to people who pay cash. The government says family physicians are not eligible “at this time,” hinting this is a possibility in the future, and Premier Smith has, in the past, been in favour of user fees for family medicine visits. Indeed, expect private-pay care wherever there are waitlists.

The government would say we’re fearmongering. That if patients choose to pay for surgery, the public waitlist gets shorter. But evidence from other countries shows the opposite. In countries with private-pay systems, the public waitlist actually gets longer.

And we’ve seen this closer to home. In Manitoba in the 1990s, some ophthalmologists performed both public and private cataract surgery. Public patients seeing dual-practice physicians waited over twice as long for surgery compared with patients seeing public-only surgeons. Those differences disappeared when dual practice was eliminated.

Canada already has fewer physicians per capita than many countries with dual-practice systems. Rural settings have battled staffing shortages for years. Dual practice, where richer, healthier patients can get their surgery and have everyone home by dinnertime, will make that problem worse. When doctors, nurses, operating-room staff, and already scarce anesthesiologists spend more time serving paying patients, they spend less time serving public ones.

The reason isn’t complicated. Why would surgeons do as many public surgeries when they can focus on private patients, set their own prices, and make four or even 10 times as much? And what’s the incentive to shorten public waitlists? The longer they are, the more people will turn to private pay, meaning more money to be made.

The result is longer waits for everyone else, even for critical surgeries done in the public system, like for cancer or heart issues.

Before Albertans vote on separation, they deserve clear answers about health care. Will separation make it easier to recruit physicians to rural communities? How will it affect communities’ ability to retain nurses and specialists?

And perhaps most importantly, are Albertans prepared for a future where the person with $30,000 gets surgery next week while everyone else waits? Survey results clearly say no.

The Canada Health Act is meant to ensure access is based on need, not bank accounts or credit limits. Health care in Alberta already has enough problems.

Let’s not add another one.

Dr. Paul Parks is the President Elect, Section of Emergency Medicine, Alberta Medical Association. Dr. Braden Manns is a professor of medicine and health economics at the University of Calgary.