Ontario has seen a wave of fragmented policy changes that are expanding privatized healthcare in the province, transferring the management and delivery of publicly funded services to the private sector, particularly for-profit initiatives, individuals or organizations. These shifts are often promoted as solutions to gaps in the health system, ways to increase efficiency, reduce wait times or lower costs to the public system.
Research, however, raises concerns that creeping privatization may erode commitments to health equity, healthcare access and quality of care. Canada’s public healthcare system has long been a source of national pride, built on the principle that everyone deserves healthcare, regardless of race, income or social status. This foundation of universality has been critical in reducing health disparities and promoting better health outcomes across populations.
One European study examining mixed public-private health systems found privatization is linked to negative impacts on healthcare quality, particularly among uninsured and low-income populations. These findings were echoed in a more recent review of studies from high-income countries, including Canada, which found the move from public to for-profit private delivery of services in a hospital environment generally led to worse quality of care and health outcomes, including higher rates of patient infections and avoidable deaths. Another study examined international health system rankings on access, equity and quality of care including measures of affordability, timeliness, financial barriers and access to appropriate health services. The study found countries with higher rates of private financing were associated with lower rankings on access, equity and quality of care – qualities meant to underpin medicare in Canada.
Despite commitments to universal healthcare and literature linking privatization to access and quality disparities, in Ontario, privately-owned pharmacies are now offering certain aspects of primary care, additional surgical services are being offered through private clinics, and there is a growing reliance on private staffing agencies for publicly funded health services.
Privatization in healthcare is not new, and many jurisdictions have nationalized healthcare that involves a mix of public and private service delivery. However, health workers, researchers and advocates are emphasizing the need for caution.
In response to recent expansion of private clinics, public healthcare advocates and unions in Ontario have raised concerns that such increased privatization may worsen staffing shortages by diverting workers and funding from public facilities, while worsening patient outcomes and increasing costs to access care.
Although a formal evaluation has not been conducted, several impacts of recent privatizations in Ontario have been documented. Some patients at private clinics offering cataract surgeries, a service covered by OHIP, have reported being charged extra fees. These include payments to skip waitlists or for services noted as medically necessary, both of which are prohibited under provincial and federal legislation. Additionally, an Ontario study examining the expansion of funding towards for-profit clinics found an increase in cataract surgeries among patients with the highest socioeconomic status, while those with lower socioeconomic status experienced a decline.
These changes are unfolding at a time when accessing care is already a challenge for many equity-deserving communities in Ontario. As privatization expands – in this case, in fragmented and incremental ways – it becomes difficult to evaluate its broader impact. While current literature and emerging accounts of impacts in Ontario point to potential disparities in access and health outcomes, a comprehensive picture is still lacking.
Without strong oversight on shifts towards privatization, we risk shifting the healthcare system away from its foundational principle: care based on need, regardless of a patient’s background and social conditions. To safeguard health equity, there is a need to monitor these privatization trends in Ontario with a critical eye and understand their impact on communities that have historically faced systemic barriers.
This is a developing story, and it deserves our full attention.
Wellesley Institute will be contributing to this conversation through an upcoming project examining the equity implications of healthcare privatization in Ontario.