Alberta Premier Danielle Smith’s suggestion for a health-care fee for some immigrants is not without precedent, write Nadeem Esmail and Tegan Hill.Jeff McIntosh/The Canadian Press
Nadeem Esmail and Tegan Hill are analysts at the Fraser Institute.
The government of Alberta Premier Danielle Smith may charge temporary residents between $1,400 and $1,900 to access health care in Alberta. The Premier floated the idea in September and, in the Oct. 19 provincial referendum, a slim majority of Albertans endorsed a proposal to charge a “reasonable fee or premium” for non-permanent residents to access the health-care and education systems. It remains to be seen if the government will enact such a policy.
Opponents say the proposal is “out of touch,” but the substantial influx of people into Alberta in recent years has created very real health-care challenges.
And Canadians in every province should understand that Alberta’s experience mirrors, to varying degrees, the experience of all provinces.
From 2021 to 2024, due mainly to immigration policy changes by the Trudeau government, Canada’s population increased from 38.2 million to 41.2 million, with temporary residents growing to 7 per cent of the total population.
And rapid population growth reduces access to health care for all Canadians, as increased demand outpaces the already limited supply of services. At the same time, to the extent new immigrants earn lower incomes and thus pay lower taxes than other Canadians, the amount of taxes they pay into the system won’t cover the amount of services they use, meaning immigrants create a net burden on an already stretched system.
Opinion: Alberta Premier Danielle Smith is targeting immigration. But what do the numbers say?
This may be particularly relevant for non-permanent immigrants (e.g. international students and temporary workers) who comprised the majority of all immigrants in 2024. Of course, these same immigrants may become higher income earners over time, but that doesn’t reduce the fiscal burden in the short term.
Which brings us back to Alberta. Ms. Smith’s suggestion for a health-care fee for some immigrants is not without precedent.
Australia, for example, provides universal health care to citizens and permanent residents. Temporary residents, unless they come from a specified list of countries with reciprocal health-care agreements, or are among a couple other specific classes, must pay for their own private health care. International students must purchase health-care insurance as a mandatory condition of their student visas.
Sweden, another universal health-care country, recently revised its rules for foreign nationals, requiring those with temporary (up to one year) permits to purchase comprehensive private health-care insurance. Family members staying in Sweden with students (for up to one year) must also purchase health-care insurance, while longer-term students are only allowed access to the government health-care system after one year of residency.
And in Britain, the government requires visa applicants staying for more than six months to pay a mandatory annual fee to access the National Health Service. The charge in 2026 is roughly C$1,940 per year for most adults and C$1,455 for students, children and dependants, and must be paid in advance as part of the visa application.
Clearly, Ms. Smith’s idea is not “out of touch” – it’s in line with several other universal health-care systems around the world including systems (particularly in the case of Australia and Sweden) with generally shorter wait times and greater access to physicians and medical technologies such as MRI machines. While details vary about fees and exemptions for certain populations, other countries with universal health care have recognized the fiscal burden of immigration and enacted policies to mitigate the effects.
Immigration, when properly managed, can contribute meaningfully and positively to Canada’s economic and social fabric.
But newcomers have an impact on government programs and can be a net burden on the system to the extent they work in lower-paying jobs or focus on education (and not pay taxes).
For our health-care system specifically, it’s important to recognize the realities of immigration, and the experiences of other countries, when considering new policies – in Alberta or anywhere else in Canada – to help cover the costs.