What ambulance companies cost Quebec, according to the Auditor General

The cost of ambulance companies in Quebec reached $640.8 million in 2023-2024, according to the May 2025 report of the Auditor General of Québec. These 43 companies provide ambulance services everywhere in Quebec except Montreal and Laval. The Auditor General concludes that the Ministère de la Santé et des Services sociaux (MSSS), Quebec's health ministry, has no assurance that the amounts it pays them are reasonable. This text applies to women and men paramedics alike.

One billion dollars a year

Pre-hospital emergency services cost a little over $1 billion in 2023-2024, of which $978 million came from the Government of Québec. Table 1 of the report breaks down this spending.

The 43 companies are not all private. The report counts private companies, co-operatives, non-profit organizations, an association and a municipality. In Montreal and Laval, Urgences-santé runs the whole response chain.

Where the companies' money comes from

Of the $640.8 million, $555.6 million comes from contracts with the ministry and $85.2 million from user fees. Of those fees, $18.7 million comes from citizens. The remaining $66.5 million is paid mainly by the government, for users who qualify for free transport. The user fee is explained in our article on the cost of an ambulance.

A contract without competition

The ministry and Santé Québec sign a three-year service contract with each permit holder. In practice, a standard contract is negotiated as a single block with the representatives of the four ambulance company associations.

The Auditor General writes that this contract is awarded without any competition. An ambulance services permit for a zone automatically gives the company a contract. The contract in force since October 2023 requires, for the first time, that companies send their audited financial statements to the ministry every year.

The fair price, an open question since 1998

The Auditor General already recommended in 1998 that the ministry make sure it pays a fair price for these services. In 2025, it found that the amounts were negotiated while the ministry knew little about the cost of the services provided.

It analyzed the financial statements of four audited companies, from 2020-2021 to 2023-2024.

• Earnings before interest, taxes and amortization represented 7.7% to 16.5% of revenue in 2023-2024, depending on the company
• For two companies, this share dropped sharply since 2020-2021, from 16.7% to 7.7% and from 25.4% to 11.3%
• Administration took 12.8% to 15.9% of spending
• The gap between the salaries of the chief executives reached $125,000

Three companies told the Auditor General that their operations in remote regions are less profitable, because of the premiums they pay to attract staff. The report states that these premiums are reportedly not reimbursed to them.

Performance bonuses with weak controls

The 2023 contract includes performance incentives for the first time. A company receives an allowance when its ambulances get back into service quickly after the emergency department, and pays a penalty when they leave too slowly for the patient. These calculations rely on the times paramedics enter on a form.

The Auditor General found that the institutions that check and pay these incentives do not have access to reliable data. The ministry did not know the total allowances paid or penalties applied for the first year of the contract. This text is neither legal nor union advice.

Also read: paramedic employers in Quebec and Dessercom.

Frequently asked questions

Is an ambulance company profitable?

At the four companies audited by the Auditor General, earnings before interest, taxes and amortization ranged from 7.7% to 16.5% of revenue in 2023-2024. For two of them, this share has dropped since 2020-2021. The report does not give the profitability of the other 39 companies.

What is the price of an ambulance licence?

No official source consulted gives a price. The Auditor General explains that an ambulance services permit for a zone automatically gives a contract with the ministry, without competition. The service contract lasts three years.

What are the ambulance companies in Quebec?

The Auditor General counts 43 ambulance companies outside Montreal and Laval: private companies, co-operatives, non-profit organizations, an association and a municipality. In Montreal and Laval, it is Urgences-santé, a public body. Our articles cover Dessercom, CTAQ, CETAM and Paraxion, among others.

What are the ambulance transport fees in Quebec?

The user is billed $125 for the pickup, plus $1.75 per kilometre travelled. The average cost of the services is $1,214 per transport in 2023-2024, according to the Auditor General. The average bill to the user is $154.

Is ambulance transport free in Quebec?

Not for everyone. The Auditor General names cases where the user pays nothing, for example people aged 65 or over, income security recipients and transport between two hospitals. The government then pays the bill instead.

What will the ambulance rate be in 2026?

The rate remains $125 plus $1.75 per kilometre, unchanged since 1997. The ministry began analyzing the fees in fall 2024. No decision had been made by the end of the Auditor General's work.

Sources

• Services ambulanciers, chapter 3 of the report of the Auditor General of Québec to the National Assembly for 2024-2025, May 2025, paragraphs 5, 92 to 106 and 121 to 124, table 1 and figure 8, consulted on October 17, 2026