Eroding Public Medicare: Lessons and Consequences for For-Profit Health Care Across Canada,

Executive Summary

Our main findings, in brief:


 1.  Across Canada in total we found 42 for-profit MRI/CT clinics, 72 for-profit surgical hospitals (clinics) and 16 boutique physician clinics. The surgical clinic numbers exclude those that sell only medically unnecessary cosmetic surgery and other such procedures.

 2.  Among these clinics we found evidence to suspect 89 possible violations of the Canada Health Act in 5 provinces. These include clinics that appear to be selling two-tier health care and extra billing patients for medically-necessary services.

 3.  We found an increasingly aggressive group of private company owners who are pushing provincial governments to give them publicly-funded contracts to increase their revenues (and profits).

 4.  A significant number of private clinics are now openly selling two-tier health care for medically-necessary services. In addition, a notable percentage are billing the public plan and charging patients in addition, by co-mingling medically necessary and unnecessary services to sidestep the Canada Health Act.

 5.  The number and scope of private clinics has been growing since the deep cuts to healthcare transfers and hospitals in the mid 1990s. Their expansion has increased in the last five years.

 6.  This is a new phenomenon. The first for-profit MRI clinics were opened only ten years ago, and the majority have opened in the last five years. Almost all the for-profit surgical clinics and boutique physician clinics have opened in the last five years.

 7.  To date, every region of the country has been the target of for-profit clinics’ expansion, except PEI, the Northwest Territories, Yukon and Nunavut.

 8.  A change in for-profit clinic ownership from small locally-owned companies to chains and U.S.-led multinationals is beginning to take place that holds grave implications. Some of the MRI/CT clinics are chains, some multinational. The first chains and U.S. multinational corporate takeovers of surgical clinics have emerged in the last five years. In the last several years also, at least one country-wide chain is emerging in boutique physician clinics.

 9.  We found evidence of wait times that are highest in areas with the most privatization as resources – financial and human – are taken out of the public health system.

 10. We found a demonstrable reduction in capacity of public non-profit hospitals as a direct result of staff poaching by nearby private clinics. In at least two provinces, hospitals have been forced to reduce or close down public services due to shortages worsened by staff poaching from nearby for-profit clinics.

 11. We found that out-of-pocket costs charged by private clinics are beyond the financial reach of most of the population in those provinces.


The majority of for-profit clinics are maximizing their profits by charging public plans and charging patients out-of-pocket or through third-party insurance as well. The evidence shows that for-profit delivery erodes the public health system by taking financial and human resources out of the public system and by promoting two-tier health care. In many cases, the drive of clinics to maximize revenues by billing all available sources – governments, patients and third-party insurers – is jeopardizing the equality and fairness of the public system which is supposed to assure equal access to medically-necessary hospital and physician services regardless of wealth.


There is little evidence to support the contention that for-profit ownership bears any relation to reducing wait times. In fact, in demonstrable cases, for-profit clinics have forced reductions in local public and non-profit hospitals’ services by taking staff out of local hospitals, worsening shortages in the public health system. Several provinces, including Ontario, Alberta and Manitoba, have in recent years reversed for-profit ownership opting to build capacity in the public health system instead, thereby improving access on an equitable basis.


The evidence shows that where the federal and provincial governments have acted to halt violations of the Canada Health Act, they have succeeded. But no province has adequate regulatory and enforcement regimes to stop the extra charges and two-tiering that is threatening equal access to care. And the federal government is not enforcing the Canada Health Act to protect patients from increasingly aggressive attempts to dismantle equal access to health care for all Canadians.