Premier Danielle Smith speaks at a press conference in Calgary on Monday, July 27, 2026, regarding diagnostic health services in Alberta. Photo by Brent Calver /Postmedia

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Beginning July 31, Alberta will allow adults to self-refer and pay privately for MRI, CT scans, ultrasounds, and X-rays without a physician’s referral. Alberta’s government defends the policy by pointing to countries like Germany, Switzerland, Japan, and South Korea.

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That comparison does not withstand scrutiny.

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Alberta is introducing a fundamentally different approach from the systems it invokes. Among OECD countries with universal health care, Alberta is an outlier. The key difference is not whether private-pay imaging exists. It does in some countries. The difference is who decides whether imaging is appropriate and who pays.

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In Germany, Switzerland, France, the Netherlands and the Nordic countries, most diagnostic imaging remains a medical service requiring physician authorization. Only a handful of countries with universal health care, including the United Kingdom, Australia, and New Zealand, allow limited forms of consumer-initiated private-pay imaging. Even there, clinical oversight remains the rule. Imaging requests are reviewed by clinicians, especially for CT scans which expose patients to radiation.

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Yet, Canada already allows patients to pay for non-insured services, including full-body MRI scans and other “peace-of-mind” tests. If Alberta’s goal was simply to allow healthy people to purchase optional preventive testing that is not medically necessary, no new law or major policy change was required. Alberta has instead created a direct-to-consumer preventive testing system where anyone can purchase diagnostic imaging without first obtaining a medical referral.

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That is not Japan’s model either.

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Japan’s well-known voluntary ningen dock preventive health checkups, which began in 1954, are comprehensive one- or two-day medical assessments. They include physical exams, vision and hearing tests, lung function tests, blood and urine tests, electrocardiograms, and selected imaging. Advanced imaging, such as MRI or CT, may be offered as an optional component within an organized screening program — not as a stand-alone consumer purchase. Many exams are subsidized by employers, insurers, and municipalities and occur within a co-ordinated clinical framework.

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The OECD notes that Japan lacks comprehensive national data demonstrating how frequently these private screening programs are used or their long-term outcomes.

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Japan’s health-care capacity bears little resemblance to Alberta’s. Japan has approximately six times as many MRI scanners per capita as Alberta, about 60 machines per million people compared with Alberta’s roughly 10. South Korea has about four times Alberta’s MRI capacity. Those countries also have far greater numbers of imaging technologists and radiologists.

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Simply copying one aspect of another country’s system while ignoring the infrastructure supporting it is not a meaningful comparison.

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Widespread diagnostic imaging of healthy people has repeatedly raised concerns about over-diagnosis.

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South Korea and Japan provide a clear example of this. During the 2000s, thyroid ultrasound was widely incorporated into health-screening packages. Thyroid cancer diagnoses increased approximately 15-fold, while mortality remained essentially unchanged. Researchers concluded that the surge largely reflected over-diagnosis: detecting cancers that would never have caused illness or death.