Funding hikes haven’t kept pace with rising demand and health care inflation, said Anthony Dale, president and CEO of the Ontario Hospital Association.Chris Young/The Canadian Press
Tim Vine, the head of a small Northern Ontario health care network, never expected that leading a public hospital would feel as precarious as his days running an agricultural financing startup.
But the experiences have turned out to be similar, at least when it comes to managing the bottom line, according to Mr. Vine, chief executive officer of North Shore Health Network, which oversees hospitals in Blind River and two nearby towns.
“Shoestring budgets. Massive amounts of uncertainty about when revenue will come. Anxiety about whether we can pay our vendors from time to time,” he said. “There’s a lot of worry and strategizing about what will happen if we can’t meet our obligations, which is not something I think the public is aware of, and not something that I expected in a public hospital environment.”
Mr. Vine is fixated on his sector’s financial challenges despite his hospital having more budgetary breathing room this year than in the recent past. North Shore Health Network is one of the small Ontario hospitals that was close enough to the brink that the province swooped in last year with what Mr. Vine calls “helicopter money” – surprise funding increases.
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All across Canada’s most populous province, hospitals are in dire financial straits, according to the Ontario Hospital Association, which represents 135 hospital corporations. More than 100 are forecasting year-end deficits, despite accountability agreements with Ontario Health, a provincial agency, that require hospitals to balance their books. (The government can, and regularly does, waive those obligations.)
What’s more, many of Ontario’s hospitals are running short of working capital, the money they use to pay day-to-day bills. In a January prebudget submission, the OHA predicted the sector would finish the fiscal year with a combined $1.8-billion deficit in working capital, although the final total could be lower thanks to extra funding Premier Doug Ford’s government provided last year to help small hospitals like North Shore Health stay afloat.
“Hospitals may be not-for-profit organizations, but they’re still businesses,” said Anthony Dale, president and CEO of the OHA. “If any other business was facing this kind of crisis, you would expect action. But right now, the system is grinding to a halt.”
Mr. Dale and others, including opposition politicians and unions representing nurses and hospital workers, point the finger at the Ford government. They accuse it of underfunding a public hospital system that struggles to meet the needs of a population that is growing, aging and suffering more chronic illnesses.
They’re looking for a significant boost in hospital funding when the Ontario government tables its budget on Thursday, but most critics aren’t holding their breath, knowing the government is staring down heavy economic headwinds.
“The workers in these hospitals, they are doing far more than they ever have with much less,” said Erin Ariss, president of the Ontario Nurses’ Association, a union representing more than 68,000 nurses. “When have we hit rock-bottom? When will these cuts stop?”
ONA says Ontario hospitals, long-term care homes and other health workplaces have eliminated about 700 front-line nursing and health worker positions since January of 2025, most as cost-cutting measures.
Meanwhile, the Ontario Council of Hospital Unions, part of the Canadian Union of Public Employees, has been holding rallies outside hospitals from North Bay to Ottawa to Markham to protest dozens of job cuts among its members, who include personal support workers, registered practical nurses and clerical staff, among others.
CUPE members rally outside Markham Stouffville Hospital on March 19.Azad Amin/The Globe and Mail
CUPE hasn’t released a provincewide tally of hospital job cuts. As for ONA’s total, the Ford government disputes it.
“There is no single source or verified basis for the ‘700 jobs’ claim, and the ONA and those amplifying it are being disingenuous by failing to provide or substantiate how this figure was calculated,” said Ema Popovic, a spokeswoman for Ontario Health Minister Sylvia Jones.
Ms. Ariss said ONA’s figures come from bargaining-unit presidents at each of the hospitals that have eliminated registered-nurse positions.
This dispute over job cuts follows a push by the Ontario government to get hospital budgets back to black. Last year, the province asked every hospital forecasting a deficit to draft a plan for returning to balance in three years, assuming 2-per-cent funding increases in each of those years.
As Ms. Popovic noted in a statement, the Ford government has increased hospital funding by 4 per cent a year for the past three years.
But Mr. Dale said those hikes haven’t kept pace with rising demand and health care inflation, or closed structural funding gaps. The OHA argues the hospital sector needs a funding increase of nearly $2.8-billion in 2026-27 just to be stabilized.
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Ontario already spends less per capita on hospital services than any other province or territory, according to the Canadian Institute for Health Information.
“I think that hospitals have worked to innovate in care, to use every last dollar they can,” said Lee Fairclough, hospitals critic for the Ontario Liberals and a former president of St. Mary’s General Hospital in Kitchener.
“Now we see a situation where they are increasingly in trouble, and I think that their requests to the government have been realistic.”
Making matters worse is the wave of patients with multiple, chronic conditions that health care leaders see on the horizon.
About 3.1 million Ontarians are expected to be living with a major illness by 2040, up from 1.8 million in 2020, according to an analysis by researchers at the University of Toronto’s Dalla Lana School of Public Health. The OHA commissioned the research.
“We’re going to have more people that need hospital care than we ever have experienced in this province,” said Laura Rosella, a professor of epidemiology and co-author of the analysis. “Those individuals that need hospital care, including the everyday person that’s reading this story, will most likely need care for multiple conditions.”