I keep hearing that same phrase from Queen’s Park: “same card, same care.” It’s the Ford government’s answer to basically every question about private surgical clinics in Ontario, and I’d argue it stops being reassuring once you look at what’s actually happening on ground. Since Bill 60, the Your Health Act, passed in May 2023, the province has approved 61 new for-profit “Community Surgical and Diagnostic Centres” to perform publicly-funded procedures. Nearly $300 million in public money committed. The idea was to cut wait times. Three years in, cataract surgery wait times are worse than when they started.
How we got here
Private surgical facilities aren’t new in Ontario. Shouldice Hospital has been doing hernia repairs since 1945, it’s one of the last grandfathered private hospitals under the Private Hospitals Act. The Kensington Eye Institute has been around for years. What changed in 2023 was the scale. Sylvia Jones, then health minister, pushed Bill 60 through the legislature, repealing the Independent Health Facilities Act and replacing it with a new licensing framework for what the government calls Community Surgical and Diagnostic Centres. Critics call them private for-profit clinics. Same buildings either way.
Context: Bill 60 (Your Health Act, 2023) created a new category of licensed facility that operates outside the 1971 Private Hospitals Act ban on new private hospitals. Patients use their OHIP card and don’t pay for the procedure itself. The facilities are for-profit. One thing Bill 60 didn’t specify: which body would regulate or inspect these clinics. That was supposed to come later. As of mid-2026, oversight remains thin.
First wave was cataracts, starting with four clinics in Windsor, Kitchener-Waterloo, and Ottawa. The government targeted 14,000 additional cataract surgeries per year. I’ll give them some credit for the ambition. But here’s the problem: by 2024, only 66% of cataract surgeries in Ontario were performed on time. Down from 72% in 2020. That’s not a typo, the percentage actually got worse during the privatization push. Ontario’s cataract wait times are now behind B.C., Nova Scotia, Saskatchewan, and New Brunswick.
And the government kept expanding anyway. June 2025 brought $155 million for 57 new diagnostic and endoscopy centres. December 2025, Jones announced $125 million for four orthopedic surgery clinics (OV Surgical Centre in Toronto, Schroeder Ambulatory Centre in Richmond Hill, Academic Orthopedic Surgical Associates in Ottawa, Windsor Orthopedic Surgical Centre). Target: 20,000 additional hip and knee replacements over two years.
Paying more for less
This is the part that should bother everyone regardless of where they sit on the privatization question. A CBC investigation using Freedom of Information documents found that the Don Mills Surgical Unit, owned by Clearpoint Health Network, gets paid dramatically more per procedure than public hospitals for the same surgery.
Per-Procedure Cost: Private Clinic vs Public Hospital
$1,264 versus $508 for a cataract surgery. That’s not 10% more, it’s two and a half times. Don Mills Surgical’s funding quadrupled from $1.32 million to $5.27 million between 2019 and 2022 under former Health Minister Christine Elliott. Elliott subsequently registered as a lobbyist for Clearpoint Health Network. I don’t think I need to spell out why that looks bad.
The government spent $154 million on for-profit surgical facilities between 2019-20 and 2023-24. What did that buy? 16,493 low-complexity procedures. An 8% volume increase. For context, hospital surgical activity declined by 1% over the same period.
The staffing drain
Here’s where my read on this gets less generous. Ontario has the worst nursing shortage in Canada, nurse vacancy rates rose 43% between 2022 and 2024. More than 700 nursing positions have been cut from hospitals since January 2025. Emergency rooms keep closing on weekends because there aren’t enough nurses to staff them.
So where are the private clinics getting their staff?
From hospitals. Obviously.
The Ontario Nurses’ Association has been saying this for two years, Doris Grinspun at the Registered Nurses’ Association of Ontario has been even louder about it. In 2024, one in three nurses and nearly half of new graduates expressed interest in agency or private clinic work for higher wages. Private clinics offer better hours, no overnight shifts, no weekend rotations. If you’re a surgical nurse doing 12-hour shifts in a hospital that just cut your colleagues, a 9-to-5 at a cataract clinic sounds pretty good. I don’t blame them. But the math doesn’t work if you’re just moving the same nurses from one building to another and paying the private building two and a half times more.
Context: Bill 124, which capped public sector wage increases at 1% annually from 2019-2022, was struck down by the Ontario Superior Court in 2022. But the damage was done. Ontario hospitals paid for-profit staffing agencies $9.2 billion over a decade (2013-2023). Agency costs jumped 480% in the North West, 372% in North Simcoe Muskoka. The Ford government’s private clinic expansion landed on top of a workforce which was already hollowed out.
Who benefits and who doesn’t
A peer-reviewed study in the Canadian Medical Association Journal, published August 2024, looked at cataract surgery access in Ontario from 2017 to 2022. The findings are hard to argue with. Surgical rates at private for-profit clinics increased 22% for the wealthiest Ontarians but decreased 9% for the lowest-income earners. Public hospitals, by contrast, provided equal access across income groups.
That’s the two-tier system the NDP keeps warning about, and it’s already here. Not in theory. In a peer-reviewed journal.
The upselling problem
The Ontario Health Coalition surveyed 120 patients and documented 18 in-depth cases of user fees, extra-billing, or manipulative upselling at for-profit clinics. Patients charged $3,000 to $4,000 per eye for cataract surgery. One patient, Maureen Munro, paid nearly $7,000 total. Some patients were told wait lists were “more than six months” or “years long” to pressure them into paying out of pocket, claims the Coalition says are “most likely false.”
Charging for OHIP-covered services is illegal under the Commitment to the Future of Medicare Act. But the Auditor General’s 2025 report found that only eight staff conduct post-payment audits for the entire province. Same number as 2017. Audits take over a year. The OHIP billing system can’t auto-flag suspicious claims.
Eight people. Watching $19.5 billion in physician billings. The NDP introduced the Health Care is Not for Sale Act, which would have imposed fines and licence suspensions for clinics charging illegal fees. The PCs voted it down.
What Queen’s Park is saying
Marit Stiles and the NDP have been the loudest, calling it privatization (which, fair enough, it literally is). France Gelinas, NDP shadow health minister, introduced the counter-legislation. Stiles put it bluntly: “Private health-care corporations in the United States are circling like vultures.”
The PCs point to the wait time numbers. Jones’s line: “Our government is leading the country with continued investments that have resulted in the shortest surgical wait times of any province.” For orthopedics, that’s actually true, Ontario leads nationally with 76% of knee replacements within 26 weeks. But for cataracts, the numbers went the wrong direction. You can’t claim the expansion is working when the first procedure type you expanded is now performing worse than before.
The Liberals under interim leader John Fraser support “publicly funded, publicly delivered” healthcare but haven’t offered a specific plan. Mike Schreiner and the Greens have been direct. “We’re paying more for less service,” he said, noting other provinces which went further with privatization have been backtracking.
On May 28, 2026, roughly 8,000 people marched on Queen’s Park to protest the expansion. A Nanos poll from the same period found nearly three in four Ontarians believe the government should prioritize public hospitals over private clinics.
The Canada Health Act question
There’s a background hum to all of this which most Ontario voters probably don’t think about. In January 2025, federal Health Minister Mark Holland issued an interpretation letter saying that charging patients for services typically covered by OHIP when delivered by a physician violates the Canada Health Act’s prohibitions on extra-billing. A new enforcement interpretation took effect April 1, 2026. Jones’s office said the province is “reviewing the directive.”
The enforcement mechanism is withholding federal health transfer payments. Ontario gets roughly $17 billion a year. Nobody in Ottawa wants to be the government that cuts health funding, and nobody at Queen’s Park seems worried about it. That mutual reluctance is what makes the expansion possible.
Where this leaves us
The Ford government isn’t slowing down. The 2026 budget allocated $280 million for private clinic surgeries. More procedure types are coming. The stated goal is redirecting 1.2 million patients away from public hospitals.
I looked at the expansion numbers and what strikes me is less the principle (countries with good public systems use private delivery all the time) and more the execution. Ontario is doing this while paying clinics 2.5 times what hospitals charge for the same procedure, while cataract wait times actually got worse, while the wealthiest patients gained access and the poorest lost it, while eight auditors monitor $19.5 billion in billing, and while 8,000 people marched on the legislature in protest.
That’s not a healthcare policy. It’s a bet that nobody will check the receipts.
Sources and verification: Per-procedure cost comparison ($1,264 vs $508 for cataracts; $4,037 vs $1,692 for knee arthroscopy at Don Mills Surgical Unit) is from CBC News reporting based on FOI documents. Cataract on-time rate (66% in 2024, down from 72% in 2020) is from Ontario Health reporting and CUPE analysis. The CMAJ equity study (August 2024) documenting the 22% increase for wealthiest and 9% decrease for poorest is peer-reviewed and published at cmaj.ca/content/196/28/E965. The $154 million / 16,493 procedures figure (2019-2024) is from CUPE Ontario citing provincial data. Don Mills Surgical / Christine Elliott lobbying connection is from CBC News. The 700+ nursing position cuts are from Ontario Nurses’ Association (March 2026). The 43% nurse vacancy rate increase (2022-2024) is from RNAO citing CIHI data. The $9.2 billion in staffing agency costs is from the Canadian Centre for Policy Alternatives. Patient upselling cases and the $7,000 figure are from Ontario Health Coalition’s 2024 report. Auditor General staffing (eight post-payment auditors) is from the AG’s December 2, 2025 annual report. The Nanos poll (74% favour public hospitals) is from May-June 2026. The 8,000-person protest figure is a police estimate (May 28, 2026). Bill 60 details are from the Legislative Assembly of Ontario (ola.org). The NDP’s Health Care is Not for Sale Act is confirmed via Ontario NDP press releases. Orthopedic clinic names and the $125M investment are from the December 8, 2025 government announcement. The 2026 budget’s $280M allocation is from provincial budget documents.
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