Authors: Bacchus Barua and Colin Craig
Bacchus Barua is Research Director and Colin Craig is President at SecondStreet.org
Since 2018, over 60,000 patients have died on a wait list for medical treatment in Ontario. In many of these cases, patients would have suffered with chronic pain while waiting for joint surgery, or cloudy vision while waiting for cataract surgery in their final years. However, some also died while waiting for lifesaving treatment.
The government had no problem taking tax dollars from these patients throughout their life, but it struggled with keeping its end of the bargain: providing them the health services they paid for. Incredibly, at the same time, a number of Ontario government laws essentially outlaw non-government alternatives.
This is not right. A new policy brief by SecondStreet.org includes a roadmap on how to remove the Ontario government’s legal barriers, bringing Ontario closer to better-performing European models where patients can choose: use the public system or pay for treatment at non-government clinics.
These include changes that would allow for the establishment of new private hospitals, removing the prohibition on non-government insurance options for medically necessary services, and allowing physicians to accept payment from sources other than the public insurance plan.
It’s important to understand that Ontario (and Canada) has chosen a unique, uncommon, and unnecessarily restrictive path towards universal health care. Canadian Medicare emphasizes universal government insurance coverage but does not ensure timely access to necessary care. In fact, it actively prevents it. This contrasts with other universal health care systems that put patients before ideology, regardless of whether care is provided by government or private institutions.
Consider Ontario’s Private Hospital Act which explicitly prohibits issuing new licences for any private hospital (after 1973). Other countries understand that patients don’t care if they receive treatment in a public or private hospital, so long as it is available and accessible when they need it. In fact, data from eight countries with better-performing universal systems shows non-government hospitals can represent anywhere from 7% to 100% of the total stock.
Removing provincial restrictions would allow private capital to fund and build hospitals that could become an essential partner for publicly funded care. The Ford government has already understood the valuable role played by Integrated Community Health Services Centres [ICHSC] – small, specialized clinics that primarily operate on a for-profit basis. Changing legislation to allow for comprehensive publicly-funded private hospitals is the natural evolution of this policy.
Countries like Switzerland, Germany, Sweden and Australia go even further and give patients a true choice between the public and private system. Specifically, they allow individuals to purchase private insurance for medically necessary services.
Currently, Ontarians are only able to purchase private insurance for treatments not covered by the public plan – dental care, physiotherapy, chiropractic services, etc. (often called “supplementary” insurance). Physicians are also prevented from accepting any private payments. In other words, the government has a monopoly over the funding and delivery of medically necessary care. This is why you often hear of Ontarians travelling to Quebec and outside the province for diagnostic scans and surgery.
These bans may have been somewhat defensible when Canadian Medicare was able to deliver some semblance of timely care many years ago. However, that hasn’t been true in decades. Despite a significant increase in spending over the past three decades, at last count over 230,000 Ontarians were on a wait list for care in the public system.
Ontarians understand change is needed. A 2025 poll by Leger (commissioned by SecondStreet.org) found that 56% of Ontarians support the idea of keeping the public health care system, but allowing patients to use their own money, or their extended health insurance, to pay for surgery at local private clinics if they cannot get timely care in the public system. Again, this would be in line with other universal health care countries (like Sweden, the UK, Australia and Ireland) that allow residents to purchase private insurance that covers the cost of medically necessary health care services.
Allowing patients to pay at non-government facilities would take pressure off the public system, allowing it to focus on helping those without the means to pay.
Other universal health care countries like Australia, France, Germany, Denmark, Japan, the Netherlands, and the United Kingdom also understand that allowing doctors to work in the public and private systems (dual practice) is a fundamental component of a well-functioning universal health-care system. Of course, many of these countries have guardrails to ensure there are always enough staff to maintain a robust public system.
Although Ontario has the shortest wait times for scheduled care in Canada (according to the Fraser Institute), thousands of patients continue to languish on wait lists – often with deadly consequences.
While the Ford government continues to work towards improving the public system through meaningful reform, it must also provide patients failed by the system with an alternative. The experiences of our international peers demonstrate that patient choice is not a threat, but a fundamental feature of universal healthcare.