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For Health | For Profit

Beyond public payment, private delivery: Understanding how private financing and for-profit delivery operate within Canadian healthcare 
Funded By:


Health systems in Canada are shifting to include more private financing of health care services and more for-profit investor-ownership of care delivery systems. These changes are occurring quietly, more often the result of opportunism by private actors exploiting the potential for profit, rather than explicit policy decisions. Many of these shifts are not well understood. Private-pay and for-profit health care delivery impact equitable access to health care, increase spending on low-value service, and undermine underlying values of Canadian health care systems and our ability to achieve the Quadruple Aim objective. This project responds to the urgent need to document and categorize these changes and provide tailored information to stakeholders about potential effects. 


Our goal is to lay the groundwork for future studies that investigate the impact of the uncontrolled expansion of private-pay and for-profit health care delivery in Canada in specific areas of high importance to policy makers and the public. 


Specifically, we will:

  1. Document new and emerging examples of the forms and extent of private sources of financing (out-of-pocket and/or private insurance) and delivery (for-profit, investor-owned) in Canadian health care systems, including sectors experiencing the greatest shifts.

  2. Expand and update the conceptual framework for categorizing and analyzing privatization of financing and delivery as they are happening now.

  3. Prioritize health care system sectors and/or services for future in-depth research to provide tailored information to stakeholders about potential effects of shifts in privatization of health care.

Team Members

Nominated Principal Investigator:  Lindsay Hedden

Co-Investigators & Collaborators: Sara Allin, Damien Contandriopoulos, Agnes Grudniewicz, Ruth Lavergne, Maria Mathews, Rita McCracken, Kimberlyn McGrail, Karen Palmer, Marie-Eve Poitras, David Rudoler, Sheryl Spithoff, Meredith Vanstone, Joel Lexchin, Gavin Frank, Chad Leaver, Maddi McKay

Papers & Preprints

Hedden, L., Spencer, S., Allin, S., Contandriopoulos, D., Gavin, F., Grudniewicz, A., Lavergne, M. R., Leaver, C., Lexchin, J., McKay, M., Mathews, M., McCracken, R. K., McGrail, K., Palmer, K. S., Poitras, M. E., Rudoler, D., Spithoff, S., & Vanstone, M. (2023). For health or for profit? Understanding how private financing and for-profit delivery operate within Canadian healthcare (4H|4P): protocol for a multimethod knowledge mobilisation research project. BMJ open, 13(8), e077783. 

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