“Wild West”: Private clinics extra-billing and charging user fees for health care
Across Canada, corporations are making money from the sick and injured even though the Canada Health Act prohibits extra-billing and user charges for medically necessary services.
On July 15, 2025, the Canadian Health Coalition’s Anne Lagacé Dowson hosted an online conversation about the runaway privatization of health care occurring in Canada with Ontario Health Coalition’s Natalie Mehra, researcher Andrew Longhurst and Canadian Doctors for Medicare’s Dr. Melanie Bechard.
The webinar is now available for viewing here:
Recently, the Ontario Health Coalition registered 50 complaints with the Ontario and federal governments on behalf of patients who were extra-billed for MRIs, cataract surgeries, and in one instance, a gender reassignment surgery.
“To be super clear, under the Canada Health Act, all medically necessary hospital and physician services are covered. That means OHIP, or your provincial health plan… cover all medically necessary services. That’s a requirement of the Canada Health Act and if the province doesn’t ensure that, then they’re supposed to have money clawed back, as a penalty, in transfer payments,” said Natalie Mehra, executive director of the Ontario Health Coalition.
“In Ontario, we’re seeing an absolute kind of Wild West among the private clinics, where they are selling cataract surgeries… We’re seeing patients being just outright extra billed,” said Mehra.
Mehra knows patients who have been charged $7,000 to $8,000 for cataract surgeries.
“People should know that your eye measurement tests, your surgery, your eye drops to follow up, all of those things are covered by the public health plan, including the unique lens that your eye needs,” said Mehra who denounced the extra-billing occurring in eye care.
Mehra noted that for cataract surgeries, people are being told if they pay, they can get the surgery within two weeks.
“It’s a travesty”
“Patients are fooled into believing that the wait times are really long. The truth is, in Ontario, we have a wait times website, and other provinces have tracking as well. You can see that 80 per cent of patients are being seen within 100 days, so just over three months, they’re getting in for their surgery. Even the lowest priority patients are getting in within four months or so. Nobody is waiting two years for cataract surgery in the public health system,” said Mehra.
“It’s a travesty. We have people who spent their life savings in their seventies to pay for their cataract surgery and no longer have savings for the rest of their life,” said Mehra.
Private health care is more expensive and lengthens wait periods
Andrew Longhurst is a political economist and health policy researcher, and PhD candidate at Simon Fraser University. Longhurst’s recent publications include At What Cost? Ontario Hospital Privatization and the Threat to Public Health Care (CCPA-Ontario, 2023).
Longhurst described how former Alberta Premier Jason Kenney’s Alberta Surgical Initiative outsourced health care by using public dollars to fund procedures in investor-owned, for-profit facilities.
Longhurst authored the 2025 Parkland Institute report, Operation Profit: Private Surgical Contracts Deliver Higher Costs and Longer Waits. The report disputed the Alberta government’s claims that private surgical contracts would increase capacity in the system, reduce wait times, and lead to cost-effective delivery of surgical care.
“In fact, what we have seen is that over the first five years of that Alberta Surgical Initiative, surgical volumes increased in the for-profit centres, and we saw a reduction in surgical activity, or the volume of procedures performed in public hospitals,” said Longhurst.
Longhurst noted that Alberta hospital staffing data also revealed the shifting of the workforce from the public system to the private system.
“Public hospitals are the only place where more complex procedures and emergency procedures are performed… We are seeing government policy purposefully shifting the easiest, most lucrative, most profitable patients, and those procedures into these for-profit surgical facilities,” added Longhurst.
Longhurst noted that wait times for some surgeries increased during five years of the Alberta Surgical Initiative, according to data from the Canadian Institute for Health Information.
“We have operating rooms and specialized operating room units across Alberta and across the country that are sitting idle and not used because we do not have the staff and the funding to perform procedures in that infrastructure that, keep in mind, taxpayers have already paid for,” said Longhurst.
Longhurst added that the Alberta Surgical Initiative is costing the system more since procedures in for-profit facilities are more expensive than those performed in public hospitals.
Longhurst said Ontario’s plans to commit $280 million over two years to for-profit facilities is “paving the way to two-tier health care.”
“We need to see leadership from the federal government, and a clear movement away from investor-owned, for-profit delivery of health care,” said Longhurst.
“Care is care”
Melanie Bechard is the chair of Canadian Doctors for Medicare and a pediatric emergency medicine physician at the Children’s Hospital of Eastern Ontario, and an assistant professor at the University of Ottawa.
For Bechard, corporations are taking advantage of “perceived ambiguity in the Canada Health Act.”
Bechard discussed the problem of nurse practitioners charging for primary care services.
“This care should be covered under the public umbrella. If nurse practitioners are providing primary care similar to what a primary care physician could provide then, really and truly, we shouldn’t allow this disparity,” said Bechard.
Bechard noted the interpretation letter issued by former Heath Minister Mark Holland earlier this year that clarified that “physician services provided by non-physician providers should still be covered under the Canada Health Act… [specifying] that nurse practitioner-provided care and other physician-equivalent services provided by non-MD providers will be brought under the public umbrella starting in April 2026.”
Virtual care is another concern for Bechard where patients are being charged and “we’re seeing a two-tiered system.”
“We were really disappointed to see that the interpretation letter didn’t provide that explicit clarification to shut this down and make it clear that care is care,” said Bechard.
Bechard highlighted another area of “intentional obfuscation or lack of clarity” involving the bundling of insured and uninsured services under a subscription model.
After the Telus LifePlus program was accused of extra-billing for physician services in British Columbia in 2022, the British Columbia Medical Commission filed an injunction against Telus. In 2023, the commission and the company reached a settlement and the program was found to be in compliance with BC’s Medicare Protection Act.
“There are numerous examples all across the country of these bundled insured and non-insured services. Sometimes they’re branded as executive health programs,” said Bechard. “We cannot have people charging for this medically necessary care.”
Bechard concluded by describing the Canadian Doctors for Medicare’s concerns on the growing influence of private equity investment in Canada’s health care system. The doctors call it a “direct threat to patient care, health equity, and the sustainability of our publicly funded health care system.”
Doctors Henry Annan and Edward Xie will be speaking about the Canadian Doctors for Medicare position against private equity in health care at the Canadian Heath Coalition’s research roundtable on the profitization of health care on Oct. 23 at the University of Ottawa.
