Since the announcement of “Your Health: A Plan for Connected and Convenient Care” on Feb. 2, 2023, the Ontario government has been expanding the use of community surgical and diagnostic centres to deliver publicly insured procedures and tests outside of public hospitals.
The expansions of these centres is made possible by Bill 60, Your Health Act, which received Royal Assent in May of 2023. The Bill created the legislative framework for Integrated Community Health Services Centres (ICHSC), which allows private centres to operate with public funding, while following rules intended to prevent preferential treatments (like queue-jumping) and restrict the centres from refusing an insured service because a patient will not pay for another product, device or service.
The Act has also stated that health services provided through private sectors will remain “available at no cost to patients” who are OHIP-insured. These new centres are changing how healthcare service is delivered, not who pays.
While supporters treat the guardrails as proof that the system remains one-tier for insured services, critics argue that two-tier experiences can still emerge through the paid layer around insured care, especially if enforcement is inconsistent or patients are not clearly informed about what is insured versus optional.
In June 2025, Ontario announced it would be “investing $155 million for 57 community surgical and diagnostic centres to connect 1.2 million people to publicly funded procedures.” The centres are licensed to specifically provide MRI and CT scans, as well as gastrointestinal (GI) endoscopy services.
Following the announcement, Ontario NDP MPP France Gélinas said to Global News that “this model of private delivery with public dollars is alarming and unfair […] private clinics benefit the wealthiest, while leaving the rest of us behind.”
In December 2025, Ontario announced a second major expansion focused on orthopedic surgery, saying they were “investing $125 million over two years to add four new community surgical and diagnostic centres licensed to deliver orthopedic surgeries,” and that this would “support up to 20,000 additional publicly funded procedures.”
While the Act has been in effect for nearly three years and these private clinics have been expanding since mid 2025, the Act has recently attracted outsized attention due to cataract surgery. In December 2025, the Auditor General of Ontario reported finding cases where patients were charged “directly for optional or unnecessary upgrades and enhancements without adequately informing them of their right to opt for services covered by OHIP.”
In addition to billing, one of the most repeated concerns is that funding non-hospital sites could draw scarce staff away from hospitals, potentially reducing hospital operating room or diagnostic capacity even as procedure volumes shift elsewhere.
The Canadian Medical Association Journal (CMAJ) provided a news analysis in February 2023 reporting that unions and other stakeholders warn expanded for-profit or privately operated clinic delivery could divert workers and funding from public hospitals.
The Auditor General of Ontario (AGO) has also documented provider warnings that expanding independent facilities could lead more specialists to choose clinic work over hospital practice, which could reduce hospitals’ ability to deliver care. Furthermore, outpatient surgery providers can operate independently with differing reporting requirements, meaning that decision-makers and the public may lack a complete system-wide picture needed to assess whether expansion creates net new capacity or mainly redistributes existing capacity.
Those concerns are amplified by evidence that Ontario’s surgical system already faces workforce bottlenecks, such as anesthesiology constraints that the Ontario Medical Association (OMA) links to operating room closures.
Ultimately, the government’s position is that the policy expands where insured care is delivered, while keeping OHIP as the payer and prohibiting pay-for-preference access. While critics, like CMAJ, AGO and OMA, warn that the practical outcome will hinge less on the guardrails themselves and more on how consistently they are enforced, how clearly patients are informed about insured versus optional services and whether the province can prevent improper billing and protect equity as the number of centres grows.