© 2002 Canadian Medical Association or its licensors

The vast majority of hospitals in North America areorganized as private, not-for-profit institutions. InCanada, 95 % of all hospitals are so owned. In the United States, around 10 % of all hospitals are for-profit in-stitutions, whereas 70 % are not-for-profit hospitals and the balance are public institutions (generally run by counties or municipalities). These shares have been remarkably stable over time, but in recent years for-profit hospitals have been increasingly owned by large chains.1 Debate about whether for-profit hospitals should be al-lowed in Canada is loaded with symbolism and much rhetoric. Underlying this is an important public policy choice. On the one hand, those opposing for-profit hospi-tals in Canada suggest that attention to the bottom line will come at the expense of patient care and may signal the be-ginning of an unravelling of the health care system that Canada has much to be proud of. Advocates suggest tha