Beyond public payment, private delivery: Understanding how private financing and for-profit delivery operate within Canadian health care

The expansion of private-pay and for-profit health care delivery in Canada is a significant concern threatening the principles of equitable access on which Medicare is founded. There have also been changes in corporate influences in health care, driving growth in for-profit delivery. For example, increasing numbers of investor-owned walk-in clinic networks and virtual care services, some of which involve direct billing to patients. Some private expenditures and private delivery cases are well understood and accounted for while others are evolving and more hidden, with the pandemic potentially hastening these changes. Additionally, the breadth and depth of changes differ across provinces and territories due to variability in existing policies governing private payment and delivery. Our pan-Canadian research project will collect information about current private financing and private delivery in Canada and use that to develop a theoretical framework to categorize and understand privatization as it is happening now. The project includes a national environmental scan to document core policies that underpin the public-private interfaces, highlighting differences across provinces (Phase 1); a virtual policy workshop with stakeholders to refine the framework and prioritize health system sectors and/or services in need of in-depth research. (Phase 2); and the development of policy briefs that we will disseminate to workshop participants and other policymaker organizations across Canada. This project will lay the groundwork for future studies that investigate the impact of the uncontrolled expansion of private-pay and for-profit health care delivery in specific health system sectors in Canada.