Social Policy in Ontario

Not adding up: Surgical and diagnostic privatization in Ontario

Posted on October 15, 2026 in Health Delivery System

Source: PolicyAlternatives.ca — Authors: Andrew Longhurst

PolicyAlternatives.ca/News-Research
September 28, 2026.   By Andrew Longhurst

The Ontario government favours for-profit delivery of surgeries and medical imaging, but the evidence shows this isn’t good health policy

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Summary

The Ontario government is aggressively promoting greater for-profit involvement in health care delivery. The most pronounced shift in this policy direction came in 2023 with the passage of Bill 60 (Your Health Act)—an omnibus bill intended to support the provincial government’s expansion of for-profit health care in the province.

In 2025, the provincial government awarded $280 million for newly licensed for-profit facilities to perform orthopedic surgeries and medical imaging—the largest injection of public funds into for-profit facilities outside of Quebec.

This research study analyzes how the Ontario government’s policy direction favours the for-profit surgical and medical imaging industry over public hospitals and evaluates whether this policy direction is reducing wait times and serving the public interest.

Analysis of Freedom of Information (FOI) requests and publicly available data shows the following:

• There are 918 licensed integrated community health services centres (ICHSCs, previously called independent health facilities) operating in Ontario—an increase from 902 facilities in 2023.
• Most services provided in ICHSCs are medical imaging, including diagnostic ultrasound (41 per cent) and radiography (21 per cent). Twenty-one ICHSCs are contracted by the Ministry of Health to perform plastic surgeries (eight facilities), eye surgeries (six facilities), and CT and MRI scans (seven facilities). Two private hospitals—Don Mills Surgical Unit and Shouldice Hospital—perform multiple surgical procedures and hernia repairs, respectively.
• In 2024-25, three per cent of total day surgeries in Ontario were outsourced to for-profit facilities, both ICHSCs and private hospitals.

Volume of outsourced surgeries increasing faster than public hospital surgeries

The volume of surgeries performed in ICHSCs increased from 16,873 in 2017-18 to 36,653 in 2024-25—an increase of 117 per cent. At the same time, the number of day surgeries performed in public hospitals increased from 1,263,098 in 2017-18 to 1,393,719 in 2024-25—an increase of only 10 per cent. Between 2017-18 and 2024-25, the number of surgeries performed in ICHSCs increased by an average annual rate of 13 per cent compared to 2.2 per cent in public hospitals.

For-profit surgeries and medical imaging are big business—and growing

In 2024-25, for-profit surgical and medical imaging was a $674 million industry in Ontario (out of a $77.9 billion health budget), which increased from $457 million in 2017-18—or by 48 per cent. For-profit surgical and medical imaging facilities received $4.1 billion in cumulative funding from the Ontario government over eight years (2017-18 to 2024-25).

Public payments to for-profit facilities increasing faster than hospital funding

The Ontario government’s policy direction favouring private, for-profit facilities is demonstrated when analyzing average annual funding growth in the three years following Bill 60. From 2022-23 to 2024-25, the average annual growth of public payments to for-profit surgical (22.8 per cent) and medical imaging (10.7 per cent) facilities increased faster than the average growth rate of public hospital funding (4.9 per cent).

Public payments to for-profit facilities are not transparently reported

The Ontario Public Accounts significantly under-report public payments to ICHSCs. In 2024-25, the Public Accounts report $84.7 million transferred to ICHSCs while expenditure reporting obtained by FOI puts payments to ICHSCs at $659 million. The Public Accounts under-reported payments to ICHSCs by 778 per cent in 2024-25.

Privatization is more expensive and lower quality than public hospital delivery

Across the country, outsourced surgeries and medical imaging have been consistently found to be more expensive than performing the same procedures in public hospitals. In Ontario, cataract surgeries were found to be more than twice as expensive as those performed in public hospitals and privately delivered knee arthroscopies were two to three times more expensive than performing them in public hospitals.

Evidence from Canada and internationally shows that private, for-profit health-care delivery is associated with lower-quality care, worse health outcomes, and greater risk of preventable death. A 2024 international review of 14 studies published in Lancet Public Health found “aggregate increases in privatization frequently corresponded with worse health outcomes for patients”.

Outsourcing is a gateway to two-tier health care

For-profit facilities are entrenching U.S.-style, two-tier health care in Canada through unlawful patient charges. Nearly one-third (46 out of 147) of unlawful extra-billing and user fee contraventions from 2023 to 2025—the years following the implementation of Bill 60—were related to cataracts and other eye procedures, which have been a major focus of surgical privatization by the Ontario government.

Wait times are increasing with greater for-profit involvement

Between 2017 and 2025, median wait times for eight of 12 priority procedures have increased in Ontario, including MRI scans, cataract surgeries, and all cancer surgeries. Despite the 185 per cent increase in public payments to ICHSCs for ophthalmologic procedures between 2017-18 and 2024-25, cataract surgery wait times did not improve. This trend challenges the Ontario government’s rationale that greater outsourcing of cataract surgeries reduces wait times. Ontario’s experience is consistent with the international evidence, and from other provinces, which finds outsourcing is not an effective strategy to reduce public wait times.

Conclusion and recommendations

The Ontario government’s policy direction favours for-profit—rather than public—delivery of surgeries and medical imaging. As the market grows and this corporate lobby becomes more powerful—like in Alberta—the prospect of American-style, two-tier health care becomes a greater risk.

If the privatization of surgeries and diagnostic procedures was sound health care policy, then the evidence would support this direction—but it does not. Instead, the provincial government should rethink its policy direction:

• Stop privatizing surgeries and medical imaging;
• Immediately increase public hospital funding and service capacity; and,
• Commit to evidence-based public system improvement strategies.

https://www.policyalternatives.ca/news-research/not-adding-up-surgical-and-diagnostic-privatization-in-ontario/?utm_source=CCPA+Master+List&utm_campaign=dca0f15f84-EMAIL_CAMPAIGN_2022_01_07_02_51_COPY_01&utm_medium=email&utm_term=0_243d98559a-dca0f15f84-51935605&mc_cid=dca0f15f84&mc_eid=26a8b9335a

Tags: budget, featured, Health, ideology, jurisdiction, privatization, standard of living

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