Ontario Health Coalition Analysis of Bill 60: Your Heath Act

March 9, 2023

Ontario Health Coalition


Analysis of Bill 60, Your Health Act

This legislation is ostensibly to facilitate the Ford government’s plan to expand private clinics. It replaces the  Independent Health Facilities Act. Since the government already had the power to do what it announced  publicly (privatize day surgeries and diagnostics from our public hospitals) under existing legislation, this part of  our analysis of the legislation focuses on determining what has changed in Bill 60 compared to the existing  Independent Health Facilities Act and to understand why they brought in new legislation rather than continuing  under the existing Act or amending it.  

Included among the key changes are: 

  • A provision enabling the Ford government to appoint a person or corporation that is not an employee  of the Ministry of Health with significant new powers. Currently the Director is a public civil servant in  the Ministry of Health. Under Bill 60 the “Director” or Directors have the power to create new private  clinics, expand privatization to entire new classes of private clinics and services, expand private clinics,  

oversee the transfer of licences, plan where and how many services will be provided. This person or  corporation will have wide discretion and responsibilities, including those currently in the purview of  the Minister and Cabinet. Since they may be a person or corporation — or multiple people or  corporations that are not in the public service — they are not subject to the conflict of interest, financial  disclosure, freedom of information and reporting regulations covering public servants. We could find no  provisions to stop corruption. 

  • A new provision explicitly shielding the new private clinic applicants’ information from freedom of  information legislation. 
  • A schedule that deregulates a range of health care staff from physicians, through nurses to health  professionals, not only in the private clinics but also in other parts of health care. The implications are  significant. For example, the restrictions on who can do surgeries, be Medical Directors in long-term  care homes, assess patients and residents, bill OHIP, dispense narcotics, restrain a resident in a long term care home or operate an x-ray machine which produces radiation have been deregulated and left  to new regulations that have not been disclosed to the public.  

The Ford government changed the rules of the Legislature to be able to pass legislation much more quickly than  was previously the case. Bill 60 was introduced on the first day of the current legislative session. Prior to the  introduction of the legislation, there was no White Paper, no democratic discussion about the plan to privatize  core public hospital services, and no public consultation. These would be normal processes in a parliamentary  democracy for major changes to important legislation. We have not been able to find a single patient advocacy  organization that was consulted, not even privately. The bill passed first reading in one day, was introduced for  second reading without any amendment despite concerns raised by health advocates and organizations, and  passed second reading within two weeks. There has been very little time to compare Bill 60 to existing  legislation to see what has changed and assess the implications. In context, Bill 60 amends at least 27 pieces of  legislation, repeals two acts and repeals multiple sets of regulations. It is a time-consuming undertaking to cross reference these pieces of legislation to understand the implications of all the changes. It is not in the public  interest for the Ford government to repeatedly push through legislation with unprecedented speed before there  is opportunity even to ascertain what is in it.

Note: Under Bill 60, the private clinics are named “Integrated Community Health Service Centres”. However,  Ontario already has Community Health Centres which are very different than what is proposed in the new bill.  They are non-profit, community based with democratically elected boards of directors, have a deep  commitment to equity, and provide team-based primary care in the public interest. The similarity in names is  confusing. In any case, “Integrated Community Health Service Centres” is a euphemism for private clinics  currently covered by the Independent Health Facilities Act and new ones that the Ford government intends to  introduce to privatize our public hospitals’ surgeries and diagnostics. For ease of understanding, we will use the  term “private clinics”. 

Key Changes under Bill 60: 


Section 3: Enabling the Minister to appoint a Director that is a third party or corporation rather than an  employee of the Ministry 

The Director in charge of the private clinics is no longer required to be an employee of the Ministry, can be a  person not employed by the Ministry, or can be another entity entirely. The Director or Directors is/are  appointed by the Minister. 

Current provisions under the Independent Health Facilities Act (IHFA) – 

  • The Director is an employee of the Ministry appointed by the Minister. (Thus, in the current  legislation the Director subject to the requirements of Ontario’s public service regarding conflict  of interest, public access to information, financial disclosure etc. ) S. 4 (1) 
  • The Director/Directors cannot be a third party.  

Analysis: Under Bill 60, the Director(s) are empowered to create new private clinics and are given wide  discretion to do so. Thus, the Ford government has enabled any third party — including a corporation — to be  given the powers to create new private clinics. There is no provision in Bill 60 that would: prevent conflict of  interest in the Director(s) awarding of licences; require financial disclosure; ensure public access to information,  nor any additional public interest protections that are required of public servants. This change opens the door to  significant corruption. 

Section 5: Devolution of the power to expand privatization to the Director 

The “Director”, which can be any third party/corporation appointed by the Minister, can make a “call for  applications” to establish new private clinics. That call for applications can go to one person or more than one  person or corporation, or can be published in any manner determined by the Director. 

The Director can issue a licence to the applicant(s). Their decision is discretionary and the Director can prefer  any application over others. The Director can set out the limitations or conditions of the licence. 

Licences will be five years unless Cabinet passes a regulation to make them longer (which they can do without  going back to the Legislature for approval, thus rendering the 5-year limitation in the bill meaningless if they  choose to make the licences longer). The Director can make them renewable, at their discretion. The Director is  to consider the licensee’s past record with respect to compliance but is not barred from issuing or renewing a  licence in the case of poor/non-compliance. 

Current provisions under the IHFA – 

The Minister is the person who designates private clinics or classes of services that will be under the  operation of private clinics and that designation is subject to approval by Cabinet. S. 4 (2) (3) The  intention to designate new private clinics has to be published in the Ontario Gazette with 30-days notice  and that notice has to set out the services that the private clinic would provide. S. 4 (5) (7) 

Sub to these provisions, the Director can issue calls for applications and issue licences. Licences are five years in duration (no provision for Cabinet to make them longer in regulations). S. 12 

Analysis: Under Bill 60, the Director (who can be a third party, a corporation, and not an employee of the  Ministry) can issue new licences to create more private clinics with much wider discretion and more powers.  That Director may not be an employee of the Ministry and is not subject to the conflict of interest and ethics  regulations for public servants. (Note: they can appoint multiple Directors.) There is nothing in Bill 60 to stop  corruption among the Director(s). 

Under Bill 60, the Director has sole discretion over which persons or corporations they select to receive licences  to operate private clinics. In the current legislation the Director could license applicants also, but that provision  followed the requirement that the Minister determine which facilities and services would be allowed to be  private clinics. In turn, that decision of the Minister was subject to public notice and Cabinet approval. In Bill 60, the Director is given new powers to determine what classes of services would be privatized to private clinics,  how many, where, and all the health system planning implications of these. For clarity, all of these health system  planning considerations are currently the Minister’s responsibilities, not the Director’s, and certainly not a third  party’s. 

Regarding the expansion of the number and scope of private clinics: most of the current provisions for public  notice and oversight by the elected representatives of the government are taken away. There will be no public  notice, no requirement for Cabinet approval, no 30-day notice period. This enables the Ford government to  privatize very quickly and will make it very difficult to track the privatization.  

The clauses regarding the renewal of licences enable the Director(s) to renew a licence even if the private clinic  has a poor track record. The Director(s) have only to “consider” their track record, which has no effective  meaning. (Note: the requirement for a new licensee is a bit stronger and includes that the Director must be of  the opinion that the past conduct of the applicant affords reasonable grounds to believe that they will operate  in accordance with the law and in a manner that is not prejudicial to the health, safety and welfare of any  person. It is not clear yet how or whether the public could enforce this provision against the government or the  Director(s), not in the least because there will be no public notice of issuance of notices for applications, no  public access to information about applications and no time for the public to respond. In any case, those  provisions are significantly weaker for renewals.)  

Overall, the Director/Directors have wide discretion over issuing new licences and renewing licences, can  privatize entire new classes of services, will decide where and how many private clinics there are, and will  determine who or what will operate them. All of these decisions can happen with no public notice. This  legislation devolves the powers of the Minister and Cabinet to a person or entity which could be a third party or  multiple parties, including private corporations.  

Section 5 – Enabling Upselling: 

Under Bill 60 the list of what an application for a licence will include is more detailed than in the current Act.  Among these provisions is the “upselling” provision. S. 5 (4)(i). In this section, the private clinic applicant is 

required to describe any uninsured services and charges for them (upselling), and their planned method for  obtaining patient consent. 

Under the IHFA – 

There is no such provision.  

Analysis: The detail in this section seems positive upon first reading. However, while the applicants have to write  up a plan for each item, they are no actual standards. The requirement is only that the applicant submit the  information, not that they meet any particular standard regarding the listed items. As such, it is good for PR but  meaningless. In reality, there are no standards in the Act and the determination of what corporations get licences to operate private clinics is left almost entirely to the discretion of the Director(s). There may be some  standards in regulations, which can be changed by Cabinet at any time without going back to the Legislature, or  there may not be. Disturbingly, in the notice of regulation, currently posted on the regulations website, the  government is promising to “reduce red tape” in the regulations – which means deregulation, the opposite of  stronger standards and actual enforcement. 

Further, the practice of upselling to patients is extremely problematic. Inviting private clinics to sell an array of  medically unnecessary procedures and tests poses a significant risk to equity and access to care for patients. The  (perhaps unintended) consequence of this section is that it actually invites the private clinics to co-mingle  medically unnecessary with necessary services, a practice that is common in cataract surgeries currently, but has  not been the case in hip and knee surgeries, and is just starting to creep into medical imaging. It is extremely  difficult – if possible at all – to police such co-mingling and upselling, and the practice has been widely exploited  to manipulate patients into paying for thousands of dollars for medically unnecessary services. The extra charges  are often far more than the cataract surgery itself costs under OHIP. Inviting private for-profit corporations to  dream up more medically unnecessary procedures and test to sell to patients is reckless. This section is deeply  problematic.  

Sections 19 – 23: Secrecy, accountability, standards  

Section 19 (3) states that all information collected in relation to an application for a licence shall be kept  confidential and thus will expressly not be available for public scrutiny under the Freedom of Information and  Protection of Privacy Act.  

The private clinics will be required to have their own internal processes for dealing with complaints.  

The private clinics are supposed to be required to meet safety, quality, inspection, and reporting standards but  there are no standards in the legislation. They are left to regulation and will apply only if the government makes  regulations for them. 

Under IHFA – This secrecy provision does not exist. 

Analysis: Much of this section of the legislation remains the same, however in Bill 60 the Ford government has  included a specific clause to exempt application for licence information from public access to information, a  provision which is not in the current Act. There is virtually no way that the public could challenge a licence  applicant based on their history of behaviour. The public will not know who is being asked to apply for a licence,  what services they are privatizing and where, who has applied, and what claims they have made about their  operating plans and history of compliance. In any case, there is no public consultation and no provision for  public input, nor even complaints. Vital information about the applicants for licences to operate private clinics  will be excluded from public access to information.  

There are no actual standards in this bill. 

Section 43: Inspections 

Inspections will not be done by the Ministry of Health directly. It is left to regulations, if any, to prescribe what  organizations/who is to be the inspecting body. That third party will set all of the standards to which they  inspect or assess facilities, including any provisions (or not) for making summaries of inspection reports available  to the public, the frequency and all details regarding the inspections, if any. 

Under IHFA – 

The College of Physicians and Surgeons is specified as the inspecting body. 

Analysis: In the existing inspections regime there have been significant problems. The Provincial Auditor  reported that the majority of facilities were not inspected for public safety requirements such as shielding  patients from radiation. In another recent report, the Auditor found that there is little monitoring and  enforcement of questionable billing practices in and that patients were being charged for services in private  clinics with inadequate oversight or controls over such practices. Even after significant public outcry and  pressure after poor quality issues and harm to patients, the inspection regime remains inadequate and  secretive. Inspection reports for private clinics posted online include only one word or one sentence and no  other information. A significant number of the clinics have not been inspected in years. Under the new bill there  is no improvement in the inspection process, public access to information and public accountability regimes, and  it is not clear what entity the Ford government intends to contract as the inspecting body. Note: once it is  outside of the Ministry, public access to information legislation does not apply and it is much more difficult– if  at all possible – to obtain public disclosure.  


This schedule deregulates the definitions of key health care staff including: 

  • Under the Commitment to the Future of Medicare Act (2004): the definition of physician is changed to  include both a physician lawfully entitled to practise medicine in Ontario “or another prescribed person”  which means that they can include others by regulation (passed by Cabinet alone).  
  • The same change to deregulate who can be defined as a physician is made under the Fixing Long-Term  Care Act (2021). Currently, under the Act, the Medical Director of the facility must be a physician. With  this change, it could be a physician or someone prescribed in new regulations. Currently a physician  assesses ALC patients for eligibility for LTC admission, does assessments of residents, determines  capacity to attend hearings appealing ineligibility, makes orders regarding the use of restraints. With this  change, it could be a physician or someone prescribed in new regulations. 
  • The definition of nurse in the Fixing Long-Term Care Act (2021) is similarly changed to include both a  nurse under the Nursing Act (1991) or a person prescribed by the regulations. Currently, each LTC home  must have at least one RN on duty and present 24/7 and a Director of Care who must be an RN. With  this change, they could be a person who is not a nurse as prescribed in the regulations. Currently, only  nurses and physicians can approve the use of a PASD, can assess residents for admission, and can assess  ALC patients. Again, with this change, it could be a person prescribed in the regulations.  
  • The definitions of registered nurse in the extended class (nurse practitioner) and registered practical  nurse have similarly been changed and left to regulations. As above this impacts who can make orders  for the use of restraints (currently a physician or nurse practitioner) and do the specific nursing role  provided by an RPN.
  • Under the Fixing Long-Term Care Act (2021) the Ford government is proposing new powers to make  regulations under this Act: 

o prescribing persons who are “physicians”, “registered nurses”, “registered nurses in the  extended class” or “registered practical nurses” for the purposes of this Act or for the purposes  of specified provisions of this Act; 

o establishing and governing limitations, terms or conditions on the manner in which persons  referred to in paragraph 8.1 may carry out their duties and responsibilities under this Act and  the duties of licensees with respect to those persons. 

  • Under the Gift of Life Act (1990) the definition of physician is changed, as above, to include not only  physicians licensed to practise in Ontario but also anyone prescribed in the regulations. This affects who  is able to examine and remove tissues for transplant, who can determine capacity for consent, who can  determine the fact of death, who can receive personal health information about donors. 
  • Under the Healing Arts Radiation Protection Act (1990) the definition of who can operate an x-ray  machine (which irradiates the patient) is changed to include both a legally qualified medical practitioner  and “another person as prescribed” in regulation and both an extended class RN (nurse practitioner)  under the Nursing Act (1991) or “another person prescribed by the regulations”. 
  • Under the Health Insurance Act (1990) the definition of physician is changed to include both legally  qualified medical practitioner lawfully entitled to practise medicine in the place where medical services  are rendered by the physician “or another prescribed person”. This primarily impacts who can bill OHIP  and be paid for physician services. 
  • Under the Medical Laboratory Technology Act (1991) “No person other than a member shall use the title  “medical laboratory technologist”, a variation or abbreviation or an equivalent in another language” and  “No person other than a member shall hold himself or herself out as a person who is qualified to  practise in Ontario as a medical laboratory technologist or in a specialty of medical laboratory  technology.” The amendments enable Cabinet to make regulations exempting a person from those  sections of the Act. This impacts who can conduct laboratory investigations on human beings or  specimens taken from the human body. 
  • Under the Medicine Act (1991) “No person other than a member shall use the titles “osteopath”,  “physician” or “surgeon”, a variation or abbreviation or an equivalent in another language,” and, “No  person other than a member shall hold himself or herself out as a person who is qualified to practise in  Ontario as an osteopath, physician or surgeon or in a specialty of medicine.” The amendments would  enable Cabinet to make regulations exempting a person from these requirements. This is self-evident. It  impacts who can call themselves an osteopath, physician or surgeon. 
  • Under the Narcotics Safety and Awareness Act (2010) currently only designated health professionals as  defined in the Regulated Health Professions Act (1991) can dispense a monitored drug, collect personal  health information, ensure that regulations regarding verification of identity are met, keep appropriate  records of the dispensing of monitored drugs. Under the changes, Cabinet can make regulations to  

designate another person to do these functions. Similarly, the definition of “prescriber” is changed to  include a person designated in regulations.

  • Under the Nursing Act (1991) “No person other than a member shall use the title “nurse”, “nurse  practitioner”, “registered nurse” or “registered practical nurse”, a variation or abbreviation or an  equivalent in another language,” and “No person other than a member shall hold himself or herself out  as a person who is qualified to practise in Ontario as a nurse, registered nurse, practical nurse or nurse  practitioner or in a specialty of nursing.” Under Bill 60, Cabinet can make regulations exempting a  person from these requirements. 
  • The Pharmacy Act (1991) is changed to change the scope of practice for pharmacists to add in “the  assessment of conditions for the purposes of providing medication therapies.”  
  • In the Public Hospitals Act (1990) the definition of physician is changed from being “a legally qualified medical practitioner” to “a member of the College of Physicians and Surgeons of Ontario or another prescribed person” and the regulations section of the Act is changed to include powers for Cabinet to  make regulations prescribing who can be considered a ‘physician’. 
  • Under the Respiratory Therapy Act (1991) “No person other than a member shall use the title “respiratory therapist”, a variation or abbreviation or an equivalent in another language,” and, No person other than a member shall hold himself or herself out as a person who is qualified to practise in  Ontario as a respiratory therapist or in a specialty of respiratory therapy”. This section is amended to  enable Cabinet to make regulations exempting a person from these requirements. 

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