Social Policy in Ontario

We’re already facing the consequences of two-tier health care. Doug Ford is opening the door to make it even worse

Posted on January 20, 2026 in Health Policy Context

Source: TheStar.com — Authors: Lhamo Dolkar and Doris Grinspun

TheStar.com – Opinion/Contributors
Jan. 20, 2026.   By Lhamo Dolkar and Doris Grinspun, Contributors

Alberta’s push toward for-profit health care has been making headlines, drawing criticism and public concern. But while attention has focused westward, Premier Doug Ford and Health Minister Sylvia Jones have quietly been moving Ontario toward profitization.

The Ontario government’s decision to increase the number of orthopedic surgeries by funneling tax dollars to private clinics continues with the troubling shift in how surgical care will be delivered in this province. While reducing wait times is a goal we all share, funding private, for-profit expansion while publicly funded operating rooms sit underused and nurses remain unavailable is not the solution.

Four Ontario facilities have been selected to deliver additional hip and knee replacements beginning in 2026. Importantly, some of these facilities already offer, or are positioned to offer, privately paid procedures alongside publicly funded ones. One centre is part of a national, investor-owned chain that openly markets private-pay surgeries, and others have corporate structures well suited to introducing uninsured services. This means patients will receive OHIP-funded care in facilities that simultaneously market faster access or enhanced options to those who can pay — a textbook two-tier arrangement that undermines fairness and public trust.

Ontario’s public hospitals already have the operating and recovery rooms and clinical expertise to expand surgical care. The latest data shows Ontario is short nearly 29,000 registered nurses compared to the rest of Canada. Yet, instead of fixing this, the government is diverting resources to for-profit centres, which risk pulling even more nurses away from delivering complex and emergency care in hospital.

For Ontarians who require surgeries, this two-tier approach also introduces serious risks. Unlike public hospitals, private surgical centres do not provide round-the-clock care. When complications arise patients must be transferred to public hospitals, often in distress and without continuity of care. These gaps disproportionately affect those with limited mobility, chronic illnesses or a lack of family support, leaving them vulnerable to delays and fragmented treatment. Rather than building a stronger, more equitable public system, the government is widening the divide between those who can navigate a commercialized system and those who cannot. This experiment has already failed.

The financial case for this shift is equally weak. In every jurisdiction where contract prices have been disclosed, private clinics charge higher per-procedure costs, driven by profit margins, administrative overhead and duplicated infrastructure. Public hospitals, by contrast, can expand surgical capacity at lower marginal cost using existing infrastructure. Diverting funds to profit-driven facilities fragment care while draining staff and resources from our public hospitals.

Also concerning is profit-driven clinics often cherry pick the less complex, healthiest patients and send any complications back to hospitals already under strain. The result? Hospitals have even less funding to address the hardest, most expensive cases.

Yet, the door is now wide open to a major expansion of for-profit health care thanks to Ontario’s Bill 60. The bill contains no obvious limits on outsourcing publicly funded health services to the private sector.

Nurses are sounding the alarm bell. For us, health care is a universal right, not a business. We say that there is a better way forward. Ontario can reduce wait times and strengthen equity by taking decisive steps to reinforce — not abandon — the public not-for-profit system. This requires the government to:

• Expand surgical capacity within public hospitals, making full use of existing operating-rooms hours by funding extended hours — evenings, weekends and targeted surge schedules — rather than spending more to duplicate services in for-profit facilities.
• Stop the spread of two-tier care by prohibiting private surgical operators from offering privately paid add-ons or expedited pathways alongside publicly funded procedures.
• Require full transparency from these operators on patient outcomes, staffing impacts and detailed financial costing — so Ontarians know how public dollars are being used and whether safety, quality and equity standards are met.
• Implementing centralized, transparent wait-list management to ensure that access to surgery is based on clinical need, not ability to pay or clinic-level incentives.
• Reinforcing the nursing workforce — beginning with retention, then recruitment — through competitive compensation, safer working conditions and strategies that keep experienced nurses in the system while attracting new ones. Without solving the nursing crisis, no surgical backlog strategy will succeed.

When health care is delivered for profit, patients face higher costs, greater pressure to purchase add-ons, and poorer outcomes. Ontarians must confront the direction their government is taking and demand better from their elected representatives. Ottawa must do the same by upholding the Canada Health Act and ensuring federal health transfers strengthen public delivery and categorically reject policies that entrench a two-tier, for-profit system.

Lhamo Dolkar is a practicing NP and the president of the Registered Nurses’ Association of Ontario (RNAO). Dr. Doris Grinspun is RNAO’s chief executive officer.

https://www.thestar.com/opinion/contributors/were-already-facing-the-consequences-of-two-tier-health-care-doug-ford-is-opening-the/article_ba29d4d4-c2d6-40d0-b67f-bb932d068795.html

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

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