Alberta’s dual-practice health-care system took effect Sept. 1, and the federal penalty most often named as the check on it, a clawback of the Canada Health Transfer, cannot produce a single dollar before March 2029 under the reporting rules that govern how the Canada Health Act is enforced.
Bill 11, the Health Statutes Amendment Act, 2025 (No. 2), creates a category of “flexibly participating physicians” who can decide on a case-by-case basis whether to bill the Alberta Health Care Insurance Plan for a service or charge the patient privately. According to the province, the model covers specialists in orthopedics, cataract surgery, gynecology, ophthalmology, select ear, nose and throat procedures, plastic surgery and dermatology. Protests were held as the legislation came into force, CTV News reported.
The question dominating coverage since has been whether the model breaks the Canada Health Act. Alberta says it does not, arguing the Act permits provinces to set conditions for private care delivered by physicians who have opted out of the public plan. A legal analysis published by the Canadian Health Coalition concluded the opposite, finding that authorizing dual practice for medically necessary services contravenes the Act’s prohibitions on extra-billing and user charges, along with its requirements that a provincial system be comprehensive, universal and accessible.
Far less examined is what actually happens next, and when. The answer is set out in the Canada Health Act Extra-billing and User Charges Information Regulations, which require provinces and territories to report to Health Canada each year on charges levied in the fiscal year two years prior. Deductions are then announced each March. In March 2024, Health Canada announced more than $79 million in deductions for patient charges levied during 2021-22. In March 2025, it levied more than $62.2 million for charges during 2022-23.
Apply that cycle to Alberta. The first private bills under the new regime fall in fiscal 2026-27. Under the two-year rule, Alberta reports them in the cycle covering that year, and the matching deduction would fall in the March 2029 announcement. That means roughly two and a half years of private billing could occur before any federal financial consequence arrives.
The lag is only the first of three things the headline framing obscures. The second is that these deductions are reversible. Of the $62.2 million levied in March 2025, more than $51.9 million was reimbursed after provinces took corrective action to ensure patients were not charged for medically necessary services. A Canada Health Transfer deduction is not a fine. It is a dollar-for-dollar withholding that comes back when the charges stop.
The third is that the formula was built for a different problem. Deductions are calculated on reported extra-billing and user charges levied by physicians enrolled in the public plan. Alberta’s design deliberately routes private billing through a status that sits between full enrolment and full opt-out. Whether a flexibly participating physician’s private bill counts as reportable extra-billing is the question that determines whether the deduction machinery engages at all, and the government doing the reporting is the one that says the model complies.
That context also cuts down a number circulating widely. The figure of more than $7 billion sometimes described as being at risk is Alberta’s full annual Canada Health Transfer, not an estimate of exposure. National deductions in recent years have run in the tens of millions, and most of that has been returned.
For an Albertan booking a hip replacement or a cataract procedure this fall, the practical upshot is this: the federal backstop exists, but it is slow, partial and dependent on provincial self-reporting. Any faster remedy runs through the courts or through the federal health minister’s discretionary powers under the Act, not through the arithmetic of the transfer. Health Minister Marjorie Michel tabled the 2024-2025 Canada Health Act Annual Report in February. The next report, covering deductions taken in March 2026, will say nothing about Alberta’s new system. Neither will the one after that.
Reporting on the launch of Alberta’s dual-practice model via CTV News. Deduction figures and reporting timelines from Health Canada’s Canada Health Act annual reports and the Extra-billing and User Charges Information Regulations.
