At least 130 for-profit surgical, CT and MRI, and "boutique" clinics are operating across the country and researchers found almost 90 cases of suspected violations of the Canada Health Act, said author Natalie Mehra, director of the Ontario Health Coalition.

"The federal government has essentially abdicated its responsibility to enforce the Canada Health Act and protect patients against extra billing and two-tier health care," said Mehra. "And no provincial government has set up adequate regulatory and enforcement regimes to fulfil their requirements to protect patients in their provinces."

There were numerous instances of for-profit clinics charging public plans as well as patients, as well as openly selling medically necessary services to people who will pay to "jump the queue," Mehra said.

Of the 89 alleged violations documented in the report, entitled "Eroding Public Medicare," 29 are in British Columbia, 41 in Quebec, 11 in Ontario, seven in Alberta and one in Nova Scotia.

She said for-profit clinics made their appearance about a decade ago following deep slashes to health care in the 1990s. In the last five years, the increase has been "startling," said Mehra.

But a "decline" into an American-style system isn't inevitable, the report states, citing examples where governments have clamped down on for-profit clinics.

Mehra said she'd like to see a ban on "block fees," which patients pay to boutique clinics in exchange for access to a physician. She also called for tight restrictions, if not an outright ban, on self-referrals - the practice whereby a physician in the public system refers a patient to their for-profit practice.

Alan Davidson, a health studies professor at the University of British Columbia's Okanagan campus, said the federal government doesn't tend to enforce the rules proactively.

"The compliance with federal cross-sharing rules, as they're expressed under the Canada Health Act, is not very good," said Davidson. "The federal government has not been very assiduous in discharging this responsibility."

While the increase in for-profit clinics - some of which use ambiguities in laws to increase profits - is of concern, Davidson said it hasn't caused large-scale change.

"While the development is rightly of concern, so far it's very small potatoes," he said.

However, he said there is an "erosion of principle" underway that could have far-reaching implications in the future. He also said private clinics tend to raid health-care professionals from the public system, which already suffers a severe shortage.

"We have such an enormous manpower shortage, any poaching on that system is clearly dangerous and impedes the ability of the public system to do what it's designed to do," said Davidson.

Dr. Danielle Martin, chair of Canadian Doctors for Medicare, said there are instances where doctors will require a patient pay for services out of pocket to access those that are covered by public plans.

"Along with physician colleagues across the country, I'm profoundly concerned with the emergence of these private, for-profit clinics across the country, in terms of their effect on patients and their effect on the public health-care system," said Martin.

For-profit clinics also pose the risk of having investors or companies interfere in the practice - ordering unnecessary procedures, for example, she added.

"We hear stories about that kind of interference all the time from our colleagues in the United States," said Martin.

"We want to know that qualified health-care providers, in partnership with their patients, are making decisions about what kind of care the person needs, not an investor or a shareholder whose primary concern is profit."