OPINION: Private hospitals can help produce better universal health care

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The staunchest opponents to health-care reform in Canada oppose any private provision of hospital and surgical care, with slogans such as “the solution isn’t private profit, it’s capacity.” But in other higher-performing universal health-care systems around the world, policymakers understand that private for-profit providers help produce high-quality health care for all patients at reasonable costs for taxpayers.

Consider Sweden, which spends a similar amount of money on health care as Canada but has more doctors and medical technologies (e.g. MRI machines) and shorter wait times.

In the 1990s, amid concerns about rising health-care spending and access to health care, the Stockholm County council struck a deal with Capio, a private for-profit company, to take over the operation of St. Göran, a public hospital previously slated for closure. According to the deal, St. Göran would remain publicly funded and accessible to all patients under the same terms and conditions as other public hospitals. Here’s what happened.

In the early 2000s, shortly after Capio took over, St. Göran’s operation costs were between 10% and 15% cheaper than other hospitals in Stockholm County. More recently, in 2024, the hospital had the lowest average cost of treating patients among all hospitals in Sweden, running roughly 28% below the national average.

Of course, many Canadians would ask: What about the patients? Did St. Göran sacrifice quality of care for thrift?

Not at all. In fact, in 2025 St. Göran topped Sweden’s national ranking of total hospital quality, which measures performance across a broad range of clinical and process indicators. And it had lower levels of bed overcrowding (when patients exceed available care spaces), managing 1.7 overcrowding events per 100 available beds compared to 5.1 nationally.

This high performance also extends to the emergency room, where St. Göran has historically had shorter lengths of stay in the ER (i.e. time from registration to discharge), fewer patients leaving before treatment is complete, lower rates of unscheduled return visits and lower mortality within a week of the visit to emergency. Patients at St. Göran also wait less time to be seen in emergency, with an average wait 30 to 50 minutes lower than at hospitals with similar patient characteristics (between 2016 and 2024).

And to be clear, St. Göran’s stellar performance is not because it offers a narrow range of specialized services or focuses on less ill patients. In fact, the hospital provides services for 31 different medical specialties and has one of the busiest emergency rooms in Sweden.

Benefit is twofold

More broadly, the benefit to Swedish patients is twofold: St. Göran offers high-quality universal health care at a lower cost while also providing an example for other hospitals and regions that want to improve their performance. This competition not only creates pressure for other hospitals to perform better, but it also creates an opportunity for government hospitals to learn from St. Göran’s approach and improve the quality and accessibility of care for all Swedes.

For decades, the same voices have decried any attempt to integrate private providers in Canada’s universal health-care system. But the Swedish example demonstrates that these naysayers have it backwards. Publicly funded, private for-profit hospitals can not only outperform their public counterparts but can also drive better performance in the hospital sector through competition and help create capacity in a better universal health-care system.

– Nadeem Esmail and Mackenzie Moir are analysts at the Fraser Institute

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