Specialty & Rehabilitation Hospital
The industry — Specialty hospitals (except psychiatric and substance use)
Base industry report for 6223 →- Establishments · CanadaA
- 245
- Under 10 employeesA
- 22%
- Establishments · USA
- 861
- Employment · USA
- 259,842
- Payroll · USA
- $20.0B
Of 245 Canadian establishments with employees, 22% have fewer than ten — an industry where large establishments carry real weight.
Entry signal — what decides who wins here
Structure decidesThe binding constraint is not executional. Being better than the incumbent does not, by itself, get you in — this one is cleared with capital, an asset, or a permission.
Raise or borrow the entry ticket, or buy an operator who has already paid it. The barrier is money rather than permission, so it yields to a balance sheet — and an acquisition is usually cheaper than a start.
Measured, not forecast: the share of US establishments opening in one year that were still active later. It counts good operators and bad ones together, which is exactly why it is the honest answer to “what are the odds”. It is for the whole sector rather than this market, and the ten-year figure comes from an older cohort because no younger one has reached ten years.
This is not a probability of success, and it is not a verdict on you. No survival probability is published per market, and inventing one would be worse than saying so. What the bar reads is how much of the outcome sits inside an operator's control: green means the hurdles are ones a better operator clears, red means the binding constraint is capital, an asset or a permission rather than execution. Someone arriving with an advantage this screen did not assume can win a market shown in red.
Companies named in this market · 1
The binding constraint — entry cost + regulatory drag
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.
Specialty hospitals take referrals from across a health region or a whole province, and their funding, licence and volumes come from the provincial ministry or health authority. They compete, where they compete at all, within that provincial system; a national count of beds or spending is not a market any operator can address.
Who you would be competing with
The operators already at scale here, and whoever is buying these businesses. In most of these industries the competition an entrant meets is local, so this is who sets the terms rather than a list of everyone in the trade.
Financials & market size — sourced
Figures that came from a filing, a results release or reputable reporting, each carrying its evidence tier.
Market size, derived
Built from the competitor set upward rather than quoted from a forecast. Published TAMs in these categories are frequently reverse-engineered from each other, so any published figure is checked against the vendor arithmetic rather than trusted on its own.
Disclosed revenue from 2 of 4 named vendors. The market is at least this large.
No vendor has both a disclosed revenue and a published share.
Only a revenue floor is known — the true market is larger by whatever the undisclosed vendors earn.
Competitor set · 4 named · 2 disclose revenue
| Name | Revenue | Share | Note |
|---|---|---|---|
| Encompass HealthNYSE: EHCA | $5.9B | — | FY2025 net operating revenue, from the Q4/FY2025 results release |
| Select Medical HoldingsNYSE: SEMA | $5.5B | — | FY2025 revenue, from the segment table in the 10-K filed 19 February 2026; the rehabilitation hospital segment was $1,288.9M of it |
| The provincial health authoritiesB | not disclosed | — | Own and fund Canada's rehabilitation, chronic-care and cancer hospitals; 118 of 245 establishments in this code employ 100 or more. No Canadian hospital revenue or budget figure was opened for this record |
| The grandfathered Ontario private hospitals, Shouldice among themB | not disclosed | — | Operate under licences issued before 29 October 1973; no new licence has been granted since, and a change of ownership needs ministerial consent. Secondary sources disagree on how many remain — four in one account, seven in another — so no count is given |
Evidence
Evidence. Encompass Health's figures were read from its Q4/FY2025 results release on PR Newswire [A]. Select Medical's total revenue, its rehabilitation hospital and critical illness recovery segment revenues, adjusted EBITDA and margin series, hospital counts and Medicare revenue share were read from its Form 10-K for the year ended 31 December 2025, filed on EDGAR on 19 February 2026, with the segment figures taken from the segment table rather than from the overview [A]. Establishment counts are Statistics Canada (December 2023) and US County Business Patterns (2022) [A]; the US average of about 300 staff per establishment is arithmetic on the latter. The Ontario licensing rule is tier B: it is stated consistently by several secondary sources, but the statute text on e-Laws would not load and was not read directly, and those same sources disagree on how many private hospitals remain (four in one, seven in another), so no count is given. That a change of ownership needs ministerial consent rests on reporting of the 2012 Shouldice sale attempt, not on the statute. The reading of the Alberta and Saskatchewan establishments as publicly run auxiliary hospitals is inference from the provincial skew and is unverified. Other provinces' rules were not examined individually. The cut factor is analyst judgment.
Where the industry talks
The associations, forums and events where people in this trade actually talk shop — where to listen before entering, and where the first customers are found. Each link was opened on the date shown.
Association of inpatient rehabilitation hospitals and units; runs a fall educational conference and a spring congressional fly-in.
Site says it represents more than 8,000 physiatrists; runs the Annual Assembly and the PhyzForum member discussion board.
National association of Canadian hospitals and healthcare organizations, including rehabilitation and continuing-care hospitals.
Largest provincial hospital association; the body Ontario rehabilitation and complex continuing care hospitals belong to.
The accreditor for rehabilitation programs; its standards and peer-review surveys are what operators organise around. Site states 9,600+ accredited providers.
Trade magazine on the clinical, regulatory and technology side of rehabilitation; states a reach of more than 26,000 readers.
capmr.ca (Canadian Association of Physical Medicine and Rehabilitation) blocks automated access and was left off; Canadian operators are public, so the hospital associations are the relevant bodies.