Wait times increased for some surgeries outsourced to for-profit clinics in Ontario: report

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According to publicly available CIHI data, no benchmark has been established for MRI and CT wait times. For hip and knee replacements, 84 per cent and 82 per cent of patients met the wait time benchmark respectively in Ontario in 2025. This compares to 69 per cent across Canada for hip replacements and 63 per cent for knee replacements.

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How quickly has Ontario’s for-profit health-care industry grown?

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For-profit surgical and medical imaging is big business, the study says, and it’s growing. It argues that the provincial government is “aggressively promoting greater for-profit involvement in health-care delivery,” with the most pronounced shift in this policy direction following the passing of Bill 60, Your Health Act, in 2023, which allows more private clinics to offer certain publicly funded surgeries and procedures.

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It says there are now 918 licensed integrated community health services centres (ICHSCs, previously called independent health facilities) in Ontario, up from about 902 in 2023. Between 2017-18 and 2024-25, the volume of surgeries performed in ICHSCs increased by 117 per cent.

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Of these ICHSCs, 21 have transfer payment agreements with the Ministry of Health to perform plastic surgeries (eight facilities), eye surgeries (six facilities), and CT and MRI scans (seven facilities). The remaining 897 bill the Ontario Health Insurance Plan (OHIP) on a fee-for-service basis.

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Meanwhile, in 2024-25, for-profit surgical and medical imaging was a $674 million industry in Ontario, up from $457 million in 2017-18 (an increase of 48 per cent).

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As a share of the total public payments to for-profit facilities, medical imaging facilities received the largest share, at 92 per cent ($621.8 million) in 2024-25, while those performing surgeries received 7.7 per cent ($52.1 million).

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Why have wait times increased?

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Bill 60 formed part of the government’s efforts to decrease wait times and reduce a backlog of surgeries, but the study’s findings challenge the rationale that greater outsourcing of surgeries reduces wait times.

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It adds that this finding is consistent “with the international evidence, and from other provinces, which finds outsourcing is not an effective strategy to reduce public wait times.”

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Longhurst explained that this is because increased surgical and medical imaging outsourcing creates “fragmentation in the health-care system,” which results in longer wait times.

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“Hospital-based (delivery) tends to be more integrated and centralized, and it allows resources to be focused,” he said. “When you increase surgical and medical imaging outsourcing, you tend to create fragmentation within the health-care system, and with that comes the shifting of health-care professionals, including medical imaging technologists, surgeons, anesthetists and, importantly, operating room nurses. So it has the effect of spreading those staffing resources thin.”

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How can Ontario improve wait times?

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With this in mind, the research makes three recommendations to the provincial government: stop privatizing surgeries and medical imaging; immediately increase public hospital funding and service capacity; and commit to evidence-based public system improvement strategies.

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“When we look at the international research coming from a number of different studies, that evidence tells us that increasing public sector capacity in a more integrated, coordinated manner actually has the best evidence to support reducing wait times over the long run,” said Longhurst. He adds that the provincial government needs to recognize that the current approach is not working, and commit to a plan that implements strategies that are proven to reduce wait times, such as centralized wait lists.

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“The research has shown that we could have all Ontarians getting their orthopedic surgeries within the recommended benchmark if the provincial government adopts this as the standard operating procedure, province-wide,” said Longhurst.

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