Alberta’s Dual Practice Gamble: From Public Guarantee to Private Runway
- Occiden and Company
- Nov 24, 2025
- 7 min read
Updated: Nov 28, 2025
Picture Alberta in 2027.
A Calgary energy firm is renegotiating its group benefits. The CFO isn’t just asking, “What’s our drug coverage?” but, “Can our senior engineers access private knee surgery within four weeks if they’re stuck on a two-year public wait list?”
Across town, an orthopedic surgeon is toggling between OR lists: publicly funded cases in the morning, privately paid procedures in the evening. The EMR now flags whether a patient is funded by AHCIP, an employer-sponsored plan, a global medical policy—or a U.S. ZIP code.
In the background, an underwriter at a life and health carrier reruns the models. New products. More claims. Different risks. Insurance Business Canada
This is the world Alberta is building with Bill 11 – the Health Statutes Amendment Act, 2025 (No. 2) and its dual practice health-care model.
It’s being sold as a wait-time fix. In reality, it’s a structural rewrite of who can buy access to physicians, who pays for what, and who gets to shape the next version of Canadian health care.
From single payer to stacked payers
At the core of Bill 11 is a simple shift with massive consequences:
Physicians (starting with surgeons) can work in both the public system and private settings at the same time, so long as they meet minimum public service requirements and follow new rules. Garrett Agencies+1
Patients can access those private procedures by:
Paying out of pocket,
Using supplemental insurance (e.g., Global Medical Care), or
Having coverage embedded in employer-sponsored plans. Garrett Agencies+1
On top of that, Bill 11 explicitly:
Lets employers purchase access to private physician services as part of their health plans.
Prohibits employers from cutting or downgrading health benefits just because an employee turns 65, as long as they’re still working. Alberta.ca
In other words, Alberta is moving from a world where AHCIP is the only serious payer, to one where:
Public insurance + employer plans + supplemental global medical coverage + foreign self-pay all co-exist in a deliberately constructed ecosystem.
That’s not American-style “everyone fend for themselves” medicine. But it’s very much a shift toward multi-payer, tiered access—and a new competitive marketplace for time, attention, and surgical capacity.
Employers just became health-system stakeholders
The insurer coverage of Bill 11 is blunt about what’s coming: Alberta’s dual-practice model “could significantly reshape the province’s health-insurance market,” driving new products, higher demand for private benefits, and a redesign of plan pricing and coverage. Insurance Business Canada
In that world, employers are no longer passive cheque-writers for generic benefits. They become active architects of access:
Embedding access to private surgical capacity as a recruitment and retention tool.
Designing plans where a senior engineer with a torn meniscus doesn’t vanish for 12–18 months on a public wait list.
Offering “executive health” or concierge-style programs that guarantee fast diagnostics, extended visits, and navigation support.
Bill 11’s protection for workers over 65 is not just a nicety. It means:
A 67-year-old project manager with full benefits can still be covered for private physician access while working.
Employers competing for specialized talent now have another lever: “We not only keep your benefits; we give you faster access to surgery.”
Insurers smell opportunity—and risk
The Insurance Business piece is clear: this is a net positive opportunity for insurers, but one wrapped in thick risk tape. Insurance Business Canada
Opportunities:
Demand spike for private surgery coverage and supplemental plans as Albertans look to bypass long public wait lists. Garrett Agencies+1
Space for new product lines, especially:
Employer-sponsored plans covering private orthopedics, cataracts, and other elective procedures.
Individual global medical products that combine local private access with cross-border care.
Insurers can position themselves as navigators, not just payers—bundling second opinions, medical concierge, and international options.
Risks:
Claims volume: even a modest portion of Alberta’s 4.5M population using private coverage for surgeries could mean tens of thousands of additional claims annually. Insurance Business Canada
Workforce strain: nurses and anesthetists drifting to higher-pay private work; after-hours OR schedules; physician burnout—all of which disrupt reliability and claims predictability. Insurance Business Canada+1
Regulatory grey zones:
How far can coverage go without violating the Canada Health Act?
What happens if a province’s guardrails are challenged federally?
How do you structure policies that depend on rules still being written in regulation, not statute?
The Garrett lens: a European-style choice architecture
Garrett Agencies’ explainer deliberately normalizes the model by comparing it to Europe:
Dual practice is framed as a tool to unlock more surgical capacity by letting surgeons offer procedures privately once they’ve met public-service requirements. Garrett Agencies
Wait-listed Albertans get options:
Stay fully in the public queue, hoping overall wait times fall as some patients peel off into private care.
Use out-of-pocket or insurance-backed private surgery to move from “months or years” to “weeks.” Garrett Agencies
Global Medical Care–type policies are pitched as the bridge:
Coverage for private surgeries,
Access to hospitals across Canada, the U.S., and globally,
Second opinions and concierge navigation. Garrett Agencies
This is the “optimistic” scenario: dual practice becomes a pressure valve, not a siphon.
But that outcome is not automatic. It depends entirely on:
Guardrails (minimum public hours, caps, specialty restrictions), which will live in regulation and can be quietly adjusted. Global News+1
Operational design:
Do private lists truly run on evenings/weekends and underused capacity?
Or do they slowly cannibalize daytime teams, OR time, and staff attention?
Garrett’s subtext is honest: this model makes private coverage more practical than ever for people who value choice, speed, and mobility. Garrett Agencies
Yes, Americans can come—and they will
Here’s where it gets even more interesting.
Federal notes already acknowledge that private surgical clinics in Canada are charging out-of-province patients for faster access to medically necessary services, and that this is not a Canada Health Act violation when those patients are insured elsewhere. Open Government Portal+1
In parallel, private networks like Surgical Solutions Network / Clearpoint Health explicitly market Canadian private surgery to patients across Canada, the U.S., and other countries. Surgical Solutions Network
Bill 11 doesn’t invent medical tourism—but it supercharges Alberta’s ability to play in that space:
Dual practice makes it easier for Alberta surgeons to:
Maintain a public caseload and
Offer private lists that could include non-resident patients.
Employers and supplemental insurers can build packages that bundle:
In-province private surgery, and
Out-of-country options where needed.
So yes: this absolutely opens the door wider for Americans flying in to spend money on surgeries in Alberta—especially high-income patients and corporate clients who want high quality without U.S. prices, and who are used to traveling for care.
The real strategic question is:
Does Alberta want to be a destination for surgical exports while still claiming a rock-solid “public health guarantee” at home?
If the answer is yes, then the province must treat operational excellence and data integrity as critical infrastructure, not afterthoughts.
Governance + HIA: the invisible backbone
Bill 11 is also about how the system is wired:
It advances the shift to a sector-based governance model: acute care, primary care, continuing care, etc., instead of everything under one AHS umbrella. Hospitals move into a new governance framework under the Provincial Health Agencies Act. Alberta.ca
It amends the Health Information Act to:
Enable richer data sharing between providers for team-based “whole patient” care,
Allow more integration between ministries,
Set new standards to mitigate privacy/security risks,
Let health foundations connect with patients under clearer rules. Alberta.ca+1
These plumbing changes matter because dual practice, employer access, and cross-border care all depend on clean, trustworthy data:
You can’t coordinate public and private lists, nor prove minimum public service, without reliable EMR timestamps and audit trails.
You can’t safely share data across sectors and ministries without upgraded privacy governance.
You can’t credibly sell Alberta as a surgical destination if your operational and documentation standards are a mess.
This is where primary care, in particular, has to grow up fast. In a sectorized system, a “busy but leaky” clinic isn’t just a nuisance; it’s a systemic risk—to continuity metrics, wait-time targets, and financial integrity.
Who wins, who loses?
If Alberta executes well, potential winners include:
Patients with means or good coverage, who get more control over timing, location, and experience of surgery.
Employers, who can design benefits that genuinely protect productivity and retention.
Insurers, who gain new product lines and a bigger role in health navigation.
Clinics and surgical centres that invest early in:
Dual-practice-ready workflows,
Clear CHA-compliant billing structures,
Robust data and privacy governance.
Potential losers (or at least those at risk):
Under-resourced public programs if staff drift into higher-pay private work and guardrails are weak.
Patients without coverage or savings, if overall public capacity doesn’t actually increase and they watch others “jump the queue.”
Clinics that remain operationally sloppy, whose EMR data can’t withstand audits, whose billing practices fall foul of new penalties, and whose privacy practices don’t meet upgraded HIA standards. Alberta.ca+1
What smart operators should do now
If you’re reading this as a clinic leader, employer, or insurer, here’s the uncomfortable truth:
Dual practice is not a “health-policy story.” It’s an operating model story.
The ones who win will be the ones who treat Bill 11 as a design brief, not a headline.
Clinics / surgical centres:
Clean up billing and EMR workflows now before administrative penalties and dual-track billing collide.
Map public vs private capacity, staffing, and OR time; design guardrails that you control, not just whatever regulation eventually says.
Get ahead on HIA compliance and data-sharing agreements so you’re a trusted node in this new ecosystem.
Employers:
Start asking your advisors about private surgery benefits, global medical care, and over-65 coverage in the context of Bill 11.
Decide if you want to be a commodity payer or a strategic purchaser of access for your people.
Insurers:
Treat Alberta as a testing ground for multi-payer, dual-practice products that could eventually spread across Canada.
Partner with operations experts who actually understand the workflows and constraints on the ground—not just the legislation.
Alberta is not quietly drifting toward dual practice. It is building a new health-care marketplace in real time—with public guarantees on one side and private runways on the other.
The question isn’t whether Americans will fly in and spend money on surgeries. They already do, in other provinces and through private networks.
The real question is:
Will Alberta design this moment intentionally—so access, data, and operations hold together—or will we stumble into a two-tier system held up by duct tape and goodwill?
That’s the think piece.
From here, you can decide whether you want to be a commentator on this shift—or one of the people actually engineering how it works in practice.
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