The Shouldice Clinic is an exception in the Canadian health care system. It was founded by a surgeon in the 1940s and allowed to continue as a private hospital when Medicare was established in the 1960s. The clinic is very selective about who they admit (i.e. if you are more than 20% of your ideal weight you will be refused) Groin repair is typically a day surgery in Ontario, but at the Shouldice Clinic it can be a 3 to 5 day stay. Factors such as these make there success rate very high. Ontario residents only pay for the difference between semi-private and private rooms versus ward rate. There are separate rates for Non-Ontario Canadian residents and out of country patients. In theory, it is illegal for doctors who bill the public health-care system to charge patients. IMHO, Canada needs to adopt a progressive two-tier healthcare system to provide timely access to healthcare and to take the strain off the public system.