Prolonged surgical wait times in Canada have prompted models exploiting Canada Health Act (1985) loopholes, often compromising care continuity. This review assesses the feasibility of private surgical facilities on First Nations lands. We reviewed modern treaties and self-government agreements of First Nations within 200 km of urban centres, analyzing provisions on legal status and health jurisdiction. Five First Nations met the inclusion criteria. Their agreements confer self-governing status with varying authority over health services, though federal or provincial paramountcy may apply. First Nations under modern treaties may have legal basis to establish private surgical facilities, addressing wait times. Legal ambiguities require further study.

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