With nothing left to cut, report warns Ontario healthcare could face an ugly future

A new report from the Ontario Hospital Association warns that any further cuts to Ontario's healthcare system, which is already under severe strain, could result in reduced access to healthcare and longer emergency wait times.

Ontario spends less per capita on hospital care than any other Canadian province

A report from the Ontario Hospital Association warns that years of fiscal restraint have strained the province's healthcare system to the point where any new attempts to pare back frontline care will only make hallway medicine worse. (Paul Chiasson/Canadian Press)

A new report from the Ontario Hospital Association says after decades of cuts, Ontario's severely strained healthcare system is the most efficient in Canada and any further attempts to pare back frontline care may lead to reduced public access to vital services that are already at or over capacity. 

The report, entitled "Ontario Hospitals: Leaders in Efficiency" was published late last week and comes during a major push for healthcare reform by Ontario's Progressive Conservative government, which won the last election on a platform of finding efficiencies and ending hallway healthcare. 

The report states that if the PC government doesn't first address the severe budget and capacity pressures currently facing Ontario hospitals, it may actually worsen the hallway healthcare problem it has promised to eliminate.

"This is without a doubt the most efficient hospital sector in the entire country,"  said Anthony Dale, the president and CEO of the Ontario Hospital Association, which advocates on behalf of Ontario's 141 hospitals.

"You can't keep asking hospitals to function in this manner. It is time for a significant investment to fix those services." 

Ontario hospital stays fewest, shortest, cheapest

Health Minister Christine Elliott announced the formation of Ontario Health Teams in the spring of 2019, billed as the largest healthcare reform this province has seen in 50 years. (CBC)

Ontario's healthcare system is the leanest in Canada, according to the OHA report. Not only is Ontario's hospitalization rate the lowest in the country, when patients do end up in a ward, their stay is, on average, cheaper and shorter than in all the rest of the provinces. 

Ontario's health system by the numbers:

  • Hospital expenditure $1,494 per capita (Cdn avg is $1,772)

  • 1.4 acute care beds per 1,000 population (Cdn avg is 2.0)

  • Program spending $10,363 per capita (Cdn avg is $12,360)

  • 6.2 days, average acute care stay in Ontario (Cdn avg is 7.5)


One of the reasons for that is no other health system in the country does things cheaper and faster than Ontario because no other provincial health system has undergone so much reform. 

As a result, Ontario still has the same 30,000 hospital beds it did when then-Premier Mike Harris launched the Health Services Restructuring Commission in 1999. 

Two decades later, the number of hospital beds in the province remains unchanged, even though Ontario's population has not just grown (27 per cent since 1999), it's grown older (there are 75 per cent more people 65 or older than in 1999).

1 in 6 hospital patients shouldn't be there

A woman with white hair in a hospital bed staring up.
About one if six Ontario hospital beds is occupied by a patient who no longer requires treatment, but can't be released from hospital. (Shutterstock)

Because Ontario has the same number of hospital beds as it did in 1999 with a larger and older population, it's much more vulnerable to what hospitals refer to "alternate level of care" (ALC) patients. 

ALC patients are sometimes referred to colloquially as "bed blockers," people who occupy a hospital bed where they no longer require treatment but can't be released from hospital.

As a group, they're the system's largest choke point and, even though it's not their fault, they are the symbol of so-called "hallway healthcare." 

"Many of those patients are in hallways because they are a patient designated as alternate level of care," Dale said. "They might need to be in long-term care, they might need to be at home, they might need to be in assisted living, but they can't because those services don't exist." 

"With so many alternate level care patients you can see the backups start to happen," Dale said, noting the blockage affects everything from emergency rooms, to elective surgeries. 

"It's a sign of a system way out of balance." 

The province's attempts to re-balance that system are already underway. 

In the spring, the Progressive Conservative government launched Ontario Health Teams, a reworking of the province's health system map that's been billed as the largest healthcare reform in the last half century.

The first few teams, which will link a region's hospitals with home-care providers and long-term care facilities, were announced earlier this month. 

"It has a lot of promise because hopefully we'll be able to tackle some of these longstanding systematic problems, such as high numbers of ALC patients, but that will take years," Dale said. "We need some breathing room and some time so the system can change."

But that "breathing room" isn't just about time, it's about treasure. The OHA report said that after decades of financial restraint, the system can't take anymore cuts without affecting patients and their families. 

"It's a situation that the government absolutely didn't create, it's one they've inherited, but the facts speak for themselves," Dale said. "Unfortunately, we're at that point."

"If the resources aren't there in the next budget, that's going to be some pretty tough trade off decisions and that's going to differ from hospital to hospital."


Colin Butler


Colin Butler covers the environment, real estate, justice as well as urban and rural affairs for CBC News in London, Ont. He is a veteran journalist with 20 years' experience in print, radio and television in seven Canadian cities. You can email him at