A confidential internal Health Ministry document reveals Alberta’s United Conservative Party government is considering implementing the United States’ main health-care billing system.
Health policy experts say this could open the door to U.S. private health insurance corporations and health-care providers.
“This is the clearest sign yet from the Alberta government that it is very interested in not just U.S.-style health care, but it also wants Alberta to have U.S. health care,” said Andrew Longhurst, a senior researcher and political economist with the Canadian Centre for Policy Alternatives.
If the UCP chooses to align Alberta’s billing system with the U.S. system, Longhurst said, that would be a “huge step” towards “creating the conditions to attract U.S. health insurers and U.S. for-profit health-care providers.”
Longhurst ties the interest in the U.S. billing system to Bill 11, the UCP’s controversial “dual practice” policy, which took effect Oct. 1. It allows eligible physicians and surgeons to work in the public system while also providing for-profit, private services, including surgeries, to paying customers.
Critics have called — so far unsuccessfully — on the federal government to intervene, arguing that dual practice undermines universal access to health care by creating a two-tier system. They say wealthier patients can pay to jump public wait-list queues, making personal income, rather than medical necessity, the dominant determiner of access.
“This is very, very troubling,” Longhurst said.
The government and the Alberta Medical Association, which represents the province’s doctors, agreed in 2022 to modernize the coding system, called the Schedule of Medical Benefits, employed by Alberta’s physicians and surgeons to charge the government for medical services and procedures they provide.
The Tyee has obtained a draft of an Alberta Primary and Preventative Health Services Ministry document, dated July 16, 2026. It shows that a committee, composed of Alberta Medical Association and government representatives, aided by a consulting firm, narrowed the options for modernizing the coding system to two.
One option is to update and modernize Alberta’s existing proprietary physician coding system. The second is to implement an entirely new coding system provided by the American Medical Association, referred to henceforth as the U.S. AMA.
Alberta’s lobbyist registry shows the U.S. AMA registered to lobby on July 17, 2020, about 15 months after the newly created UCP first formed a government following the single-term reign of the Alberta NDP, which staunchly opposes health-care privatization.
The association’s registration renewal on Aug. 6, 2026, shows it intended to lobby the premier's office, executive council, Alberta Health Services and the ministries of Primary and Preventative Health Services and Hospital and Surgical Health Services.
“The Alberta government is currently reviewing its physician coding system for medical services and procedures,” the registration states.
“The [U.S.] AMA will present its Current Procedural Terminology or CPT code set for use by the province of Alberta as a comprehensive solution to Alberta's medical services coding needs. The CPT code set provides a uniform language for coding medical services and procedures.”
The U.S. AMA is the largest physician-lobbying association in the United States. It created the CPT code about 60 years ago because it recognized the need for a uniform, standardized language to report surgical and medical procedures.
But even as the U.S. AMA seeks to embed its system in Alberta, it has been under intense scrutiny. The Donald Trump administration wants to shift financial incentives toward primary care and prevention and away from treatments after patients are ill that are more lucrative for physicians and surgeons.
Trump officials are even seeking potential alternatives to the CPT system, citing in part its lack of transparency and accountability.
Miriam Laugesen is an associate professor at Columbia University's Mailman School of Public Health and the author of Fixing Medical Prices: How Physicians Are Paid. She told the Washington Post in July that the U.S. AMA’s billing codes generated more than US$300 million a year in royalties for the organization.
Laugesen criticized the complex system for creating “layers of bureaucracy, middlemen and bills that patients can’t decipher.”
In an email to The Tyee, Laugesen said there are significant costs associated with adopting the U.S. AMA or CPT system that may not be apparent.
“Because of the pervasive nature of the coding system, once it is in place, it impacts a much wider range of public and private actors than people might appreciate initially.
“Once a system is adopted, it becomes difficult to change course, and this means health systems also are at the mercy of the pricing but face little ‘exit’ options if the prices increase.”
The joint Alberta Medical Association-government committee has yet to choose which option will proceed to full implementation. The document says they must undertake “a focused business case process for both options to assess trade-offs, validate assumptions, and address remaining areas of uncertainty.”
All this must be completed, the document states, by December 2026 to allow implementation to commence in January 2027.
Primary and Preventative Health Services Minister Justin Wright did not respond to an interview request.
Alberta Medical Association spokesperson Melissa Pennell confirmed some of its members are participating in the committee’s work that produced the draft document obtained by The Tyee. But she declined to comment further “given that this work is still underway.”
Damien Contandriopoulos studies health-care billing systems as a professor of nursing at the University of Victoria. The U.S. coding system is not used anywhere in Canada. Instead, he said, every province has a proprietary physician coding system.
But many, he said, have become “administratively heavy” and frustrating for doctors and administrators due to the accretion of increasingly complex medical services and procedures.
Provinces such as British Columbia and Quebec have started the process of “cleaning up” their systems, and he said it makes sense for Alberta to do the same.
The internal document states that “no preferred option emerged from the analysis, as each option involves different trade-offs while providing meaningful benefits to Alberta.”
But both Contandriopoulos and Longhurst independently said the two options are not equal. They don’t understand why the U.S. AMA coding system would be considered by Alberta because of the numerous major issues it would create.
The committee’s process appeared to be neutral, Contandriopoulos said, adding that the main criteria it employed to assess the options are sound — cost-effectiveness, ease of implementation and whether the system is user-friendly.
“But why did they then select the U.S. model, which doesn’t fit their criteria?” he said.
The two researchers also independently said that implementing an entirely new system would be an expensive, administrative nightmare.
Longhurst said he was shocked by the committee’s minimization of what would be involved in implementing the U.S. system within the three-year timeline negotiated by the Alberta Medical Association and the government.
“The amount of change management and time that this would consume in terms of frontline health-care resources for physicians and surgeons in Alberta would be unfathomable.”
“This would mean completely overhauling their administrative and billing systems and completely retraining all the physicians, all their assistants and all the staff who do billing support,” Longhurst said.
Contandriopoulos put it this way: “It would make everyone insane if it were to be implemented in Alberta.”
As has been well documented, the UCP’s ill-planned disintegration of Alberta’s health-care system, once the fifth most integrated in the world, has created a crisis amid a revolving door of senior managers as the UCP scrambles to restore order.
“This will create more chaos in a system that is already mired in chaos and cost overruns and growing fragmentation,” Longhurst said.
A frequent and sharp critic of the UCP government’s aggressive agenda to privatize parts of Alberta’s health-care system, Longhurst has an unsurprisingly long list of issues with the potential implementation of the U.S. coding system in Alberta.
But his main concern is that Alberta would essentially be ceding control of its health-care billing system to a U.S. organization — at a time when the Mark Carney-led Liberal government is engaged in a high-profile diplomatic campaign to uncouple Canada’s economy from that of the United States.
“This is another fiasco in the making where the province of Alberta will have its hands tied to what is effectively a U.S. corporation,” Longhurst said.
“The idea that the UCP would adopt a fee schedule that has not even been developed in the province, and will not have the governance within the province, is very bizarre.
“But you know, this wouldn't be the first bizarre thing that this government has done with its health-care system.”
If you have any information for this story, or information for another story, please contact Charles Rusnell in confidence via email.