The Department of Health has indicated it may revisit its pledge that independent sector treatment centres will not receive subsidies over the NHS tariff when their current contracts run out.
Asked by MPs about the impact of the global credit crunch, NHS chief executive David Nicholson said: "There are some really big issues for us on this. We've consistently said once those [independent sector] contracts have ended they will essentially get their money driven through patient choice, which I think is obviously going to create them some difficulties.
"We will have to think about how we manage those difficulties if we want to keep choice and contestability in the system, which I think we do."
The five-year contracts on the first wave of independent centres will start to expire at the beginning of 2010. Centres received guarantees over the number of patients they would be paid to treat and were paid a premium over the tariff price. The DH has always said those benefits would end after five years.
Hugh Risebrow, chief executive of Interhealth Canada, which runs two of the wave one centres, said the independent providers faced potential problems refinancing their loans to fund their facilities.
The NHS is contractually obliged to buy back£187m of independent centre facilities at the end of the contracts if the providers do not wish to continue operating.
Mr Risebrow said the DH was now considering refinancing the facilities itself and then leasing them back to the centres, giving them the opportunity to negotiate commercially attractive leasing arrangements.