Hospitals

Demand is not in question, and where private entry is allowed the business exists at scale. Acadia Healthcare, a listed US pure-play in behavioural health, reported 2025 revenue of $3,312.8M, up 5.0%, across 277 facilities and over 12,500 beds, and added 1,089 licensed beds in the year [A]. The same release is a warning about the economics even where the door is open: adjusted EBITDA fell to $608.9M from $709.0M, capital expenditure was $571.8M, and the company booked a $996.2M goodwill impairment [A]. Beds are expensive to add and their return is set by payers and by regulators' scrutiny of admissions. In Canada the door is mostly closed, and that is the cut. An establishment in this code must be licensed as a hospital, and hospital status, global budgets and physician billing for psychiatric in-patient care sit inside provincial health systems. The count shows it: of 74 establishments, 20 employ 500 or more and another 14 employ 100 to 499 — the public mental-health centres — and the small remainder are units and affiliates, not start-ups. If capital were no object an entrant would still have no licence to apply for and no payer to bill. What a private operator can open in Canada is a residential treatment centre that is not a hospital, funded by private pay, employer benefits and some public contracts; that sits in 6232 and should be screened there. The hospital software sold to this industry is screened separately at 6221.

In the United States this is one of the better businesses in health care. Encompass Health, which owns in-patient rehabilitation hospitals and nothing else, reported 2025 net operating revenue of $5,935.2M, up 10.5%, and adjusted EBITDA of $1,267.9M, up 14.9%, from 173 hospitals, and opened eight more in the year [A]. A focused hospital doing one thing at volume — stroke rehabilitation, hernia repair, orthopaedics — is cheaper and better than a general hospital doing it occasionally, and the US sector's 861 establishments average about 300 staff. The cut is that the Canadian version of this business cannot be started. Ontario's Private Hospitals Act allows a private hospital to operate only under a licence issued before 29 October 1973 or a renewal of one; none has been granted since, and the handful that survive, Shouldice among them, are grandfathered [B]. Elsewhere the rehabilitation, chronic-care and cancer hospitals in this code are arms of provincial health authorities: of 245 establishments, 118 employ 100 or more, and the 63 in Alberta and 31 in Saskatchewan are most plausibly publicly run auxiliary and continuing-care hospitals. Even a grandfathered licence is not a free asset — a change of ownership needs the minister's consent, and volumes and fees are set by the provincial insurer. The reachable adjacent proposition is the non-hospital surgical or diagnostic facility working under public contract, which belongs under ambulatory care (6214), not here. The hospital software sold to this industry is screened separately at 6221.