It's a world-renowned, for-profit Ontario hospital. Could Shouldice be a model for private health care?

When Ontario Premier Doug Ford recently mused about potential reforms to the provincialhealth-care system, he referenced ShouldiceHospital as an example ofthe positive role privatization couldplay.

His praise of the world-renownedprivatehernia clinic,one of only a few Ontariohospitalsallowed to operate for profit, also raised thequestion of whether it's a model that could be replicatedor would lead to theerosion ofmedicare and the creation ofa two-tier system.

The hospital, in Thornhill, just north of Toronto, is on a 20-acre country estate, complete with gardens and walking paths making it lookmore like a spa 89 licensed beds and five surgical theatres.The menuincludes entres such asrainbow trout with hollandaise sauce, roasted potatoesand french beans or coconut curry chicken with Singapore noodles.

One former patient recently quippedon Facebook that he keeps checking for "another hernia so I can have another mini vacation."

However, the hospital's main claim to fame is the number of hernia surgeries it performs,about 7,000 a year.

That means, according to the hospital, its surgeons repair more hernias in a year than most others do over a lifetime.

"Our surgeons and surgical team are second to none," John Hughes, managing directorof Shouldice Hospital, said in an email to CBC News. "Since our surgeons only do hernia repairs they are simply excellent at what they do what you do more you get better at."

Shouldice also claims that its model allows it to perform ata lower cost per case than public hospitals, and that wait times are a fraction of those in the public system.

The hospital also saysits rate of infection, complicationsand recurrence is less than 0.5 per centfor primary inguinal hernia repairs, the lowest recordedin the world.

The surgeries themselves are covered by the Ontario Health Insurance Plan.

Outside of that"we charge for a semi-private room at a rate in line with the rest of [Toronto-area] hospitals,"Hughes said."There is noextra billing for any other services for example medical, food, medication."

But because of the hospital's policythat most patients must stay at least three days or more after surgery, those room expensesgenerate significant revenue, critics say.

"Alot of people who go there, go there because they have very good private insurance,"said Ontario MPP FranceGlinas, the NDP'shealth critic, in a statement.

Founded in 1945

The hospital was founded in 1945 by Dr. Edward Earle Shouldice, who performed herniasurgeries for servicemen during World War II, according to his grandson DarylUrquhart.

"Atthe end of the war, there was this line up of people willing and wanting to get their hernia repaired. And there was a shortage of beds in the hospitals. And so my grandfather decided that the best way to handle this was to open a hospital," said Urquhart, who is also a former co-owner and former director of business development for Shouldice.

Its first location was in downtown Toronto, but as it became more popular, it moved to Thornhill, tothe estate of George McCullagh, a millionaire miner and newspaper publisher, who purchased the Globe newspaper and the Mail and Empire, merging them tocreatethe Globe and Mail.

The estate's main residence was converted into a hospital.In 1971, the province's Private Hospitals Act was amended to ban any new private hospitals, but those already in operation were grandfathered in. There are only three private, for-profithospitals left in Ontario, and one is Shouldice.

Its patients have included noted politicians and figuresincluding former prime minister Joe Clark,U.S. consumer advocateRalph Nader and U.S. Sen. Rand Paul.

In 2006, it stirred up controversy for NDPleader Jack Layton, a critic of private health care, who was accused of hypocrisy after he admitted he'd been a patient there in the mid 1990s. (Layton said he wasn't aware it was a private hospital.)

Urquhart says Shouldice'smodel of specialization has produced an efficiency and a skill set unavailable anywhere else.

"You simply can't achieve higher level efficiencies in a general factory that you can achieve in a focused factory," he said.

Model can be replicated

He says the model could be replicated, butwould require a focused initiative of specialized medical professionals.

"It has to be a concerted effort between professionals and administrative people and bureaucratic people. And that type of action typically happens in the private sector, not in the public sector," he said.

But Dr.Hasan Sheikh, vice chair of Canadian Doctors For Medicare, said there are "wonderful examples" of not-for-profit surgical centres that do high volume operations for specific ailments.

"And without that profit motive, are able to provide extremely efficient and high-quality care," he said, citing theKensington Institute in Toronto, which specializes in eye surgery, as a "great example."

"There'sa comfort in sending people to a place that does one thing and one thing only. And I think that, you know, there's no reason why that has to happen in a for-profit delivery model."

Patient stay questioned

Sheikh alsoquestionswhether hernia patients really need to stay at Shouldice for a few days after an operation.

"One of the big concerns I have is the fact that for a hernia repairwhich is a fairly simple operation and in most public hospitals is a day procedure at Shouldice,those patients are staying for three nights.

"Keeping people for longer to do the same procedure doesn't sound particularly innovative to me," he said. "And I think that when you have this profit motive itbegs this question of if these decisions are being made based on what's best for patients."

Glinas, the NDP health critic, says thousands of hernia operations are done inhospitals across the provinceby hundreds ofgeneral surgeons.

"And everybody recoups andeverybody is satisfied."

Glinasalso says that, with only a limited supply ofgeneral surgeons in the system, the more who go to private clinics means fewer "are available for the rest of us."

"Private for-profit clinics will cost us all dearly," she said. "It's deeply worrying that Mr. Ford mentioned Shouldice as a model to look to."

However Urquhart defendsthe hospital's three-day policy, saying it lessens patientanxiety and leads to fewer potential complications.

"You will get people who say'They don't need to stay.Shouldice only needs to make money and so on.' And that's not true.If Shouldice sent home the patients the same day or the next day,they would just be putting through more patients through the system."

"It makes no difference. The most important thing about the model has always been what is the best thing for the patient."