The UCP Change That Could Upend Alberta Health Care

A patient pays for a “preventative” health screen — perhaps an MRI, a panel of lab tests or a bundled assessment marketed as a comprehensive checkup. The goal is reassurance.

Instead the results come back with a series of findings: small, ambiguous and unlikely to be clinically significant. But they prompt followup imaging, repeat testing and specialist referrals. This is not an outlier. It is a predictable outcome.

As Alberta moves forward with legislation that expands access to self-referred diagnostic testing, the conversation has focused largely on access and equity — who can get tests, and how quickly.

But that framing misses a bigger shift. What is being created is not simply another pathway into care, but the foundation of a new market within the health system that will shape not just access, but utilization itself.

Private diagnostic testing is not new. Patients in Alberta can already access a range of services outside the publicly funded system and companies such as Telus Health actively market comprehensive “preventative” screening packages. These can include imaging such as MRI or ultrasound, advanced laboratory tests and various forms of fitness and nutritional assessment.

The question is not what is being introduced, but what is being changed.

The answer is endorsement. When government formally endorses self-referred testing, it does more than permit it. It legitimizes it. It signals to patients that these services are not only accessible, but appropriate — even outside traditional clinical pathways.

That distinction matters because it interacts directly with the underlying economics of these services.

Many forms of diagnostic testing operate on a straightforward model based on high fixed cost and low marginal cost. Imaging equipment requires significant upfront investment — an MRI unit can cost more than $1 million — and facilities must be built, staffed and maintained.

But once that infrastructure is in place, the cost of performing an additional test is comparatively low.

Financial sustainability depends on volume. When revenue is tied to volume, there is a natural incentive for private operators to increase utilization. Demand is not only met: it can be expanded.

This does not require bad actors. It is simply how the model functions. When testing is done outside of a clinical context and focus on specific symptoms and indicators, the pattern of findings changes. In lower-risk or asymptomatic populations, diagnostic tests tend to produce a higher proportion of incidental or borderline findings — results that are technically abnormal but not necessarily clinically meaningful.

Once identified, however, those findings generate followup actions: additional imaging, repeat testing, consultations and, in some cases, invasive procedures. What begins as reassurance-seeking can evolve into a cascade of care, much of which is managed within the public system.

This is not a critique of patients. Faced with uncertainty, most people will pursue information if it is made available.

But it does illustrate how demand can become self-reinforcing.

The question, then, is not simply whether more testing is available. It is how the incentives behind that testing shape what happens next, and whether the system is structured to absorb those consequences.

This is where the absence of clear regulatory detail becomes significant. At present, it is not clear what constraints will exist around pricing for privately delivered services under this framework. If providers are able to set their own rates, the cost of accessing care may vary widely.

If reimbursement mechanisms by government are introduced, further questions arise. Will reimbursement be based on market pricing or aligned with public system cost structures? If there is a gap between the two, will patients be expected to cover the difference?

And what happens if demand increases faster than the system’s ability to absorb the downstream effects, particularly when much of that followup remains within the public system?

These are not minor implementation details. They determine how the model will function in practice.

There is also a governance issue embedded in how these decisions are being structured. Many key elements appear to be left to regulation rather than explicitly defined in legislation, meaning they can be determined — and modified — at the discretion of the minister, without the same level of public debate or scrutiny.

Taken together, these dynamics point to something larger than a simple expansion of access. They suggest the creation of a parallel market within the health system, one that draws from the same workforce, operates under different incentives and relies on the public system to manage many of its downstream effects.

Diagnostic services depend on a limited pool of technologists and specialized staff. Expanding private pathways does not create a new workforce; it redistributes an existing one. If private settings offer more attractive working conditions, it is reasonable to expect that staff will shift. In that case, capacity does not expand so much as move, even as demand increases.

The result is not simply additional access, but a reconfiguration of how care is delivered, who delivers it and under what conditions. None of this suggests that private diagnostic services have no role to play. But it does underscore the need for clarity.

Alberta may be at the leading edge of this shift, but the underlying pressures are not unique. As wait times persist and demand grows other jurisdictions may look to similar models. That makes it all the more important to understand what is being built, because once the incentives are set, they are difficult to unwind.

The Alberta government’s changes are not just about expanding access to testing. They are creating and embedding a model in which the generation of demand for health care services becomes inseparable from the delivery of care.

Once that shift occurs, the system is no longer simply responding to need but increasingly shaping it.