Poor planning and oversight block path to improved primary care, Ontario auditor general says
The Ontario government has vowed to fix the
, but lack of government planning and co-ordination is getting in the way, says the province’s auditor general, Shelley Spence.
Health, the biggest budget item in Ontario, was a key focus of the auditor general’s report on Tuesday. In addition to primary-care access, it looked at the province’s oversight of doctor billing and management of PPE (personal protective equipment) stocks.
Approximately two million Ontario residents
do not have access to family doctors or primary caregivers
. The Ontario government has promised to match every resident with primary care by 2029, but provincial government actions have been fragmented, poorly planned or nonexistent, according to the annual report.
The province “did not consistently have processes in place to plan and oversee programs and initiatives to improve patients’ access to primary care,” or even fully understand primary-care needs, according to the report.
Among concerns raised in the audit was the rising number of municipalities taking on the job of physician recruitment in an effort to fill gaps without provincial co-ordination.
“The lack of a provincial entity that is responsible for coordinating physician recruitment in the province has resulted in a fragmented and competitive approach to recruitment,” the report said.
The report noted that municipalities representing 89 per cent of Ontario’s population were collectively spending more than $6.3 million a year to recruit doctors. Among the concerns is that this approach will result in unequal access to primary care depending on where people live.
“Access to and delivery of health care are provincial responsibilities that require system-level planning and resources, increasing the importance of a coordinated provincial strategy to recruitment,” the auditor general’s report said. “Failure to co-ordinate physician recruitment at the provincial level could lead to greater inequities in primary-care access in Ontario. This could also put pressure on municipalities and individual organizations to compete and develop costly solutions.”
Ottawa joined the list of Ontario communities actively recruiting doctors
earlier this this year. The city’s recruitment strategy does not involve offering financial incentives, but it will provide help finding locations and other support.
The report also found that the Ontario government expanded medical school seats, as part of an effort to improve access to care, without properly analyzing how many seats were needed or whether medical schools had capacity. By the end of the 2025/2026 academic year, medical schools had rolled out 44 per cent fewer family medicine seats than planned due to a lack of training clinics.
The auditor’s report was critical of Health Care Connect, the provincial system for matching residents with primary care, saying it had failed to meet demand. More than 100,000 Ontario residents on the list have been waiting more than a year to be matched with doctors, and the number of people on the wait list represent just 11 per cent of Ontario residents in need of family doctors.
Health Care Connect is not widely supported by primary-care providers or accessed by Ontario residents, and Ontario Health Teams have told the Ministry of Health that they no longer support the outdated tool to match patients with physicians and that it needed a redesign.
Beyond primary-care oversight, the audit also found that more than one billion items of personal protective equipment — valued at $1.4 billion — were written off between 2021 and 2025, and more stock was projected to expire in coming years.
Supply Ontario does not use a modern inventory system — relying instead on a manual process — to track and manage quantities and costs of PPE, “limiting its ability to monitor performance and respond to demand,” the audit said.
The auditor also found that the OHIP billing system did not have the ability to automatically flag unusual or high-risk billings by doctors, including physicians claiming more than 24 hours of work in a day. Unusual billings are usually only found after the physician has been paid, and many are missed, according to the audit. A system modernization initiative has been delayed and audits can take more than a year to be completed because of a lack of resources.
The audit found that 59 physicians billed 24 or more hours of service for at least one day and the number of physicians billing 24 hours or more in at least one day increased by 39 per cent between 2022 and 2025. More than 100 physicians claimed to have worked all 365 days in a year, according to the review. The review also found cases where physicians billed for more than 500 patients in a single day and had not undergone a post-payment audit.
The Ministry of Health primarily relies on tips and complaints for post-billing audits.
“While tips and complaints provide value in detecting inappropriate billings, they do not replace the need for performing analysis of claims data proactively and independently,” the auditor general’s report said. “Through our own data analysis, we identified specific examples of physicians in various specialties with notable billing concerns or risks that had not been audited.”
Using a proactive, rather than reactive, approach could save millions of dollars, according to the report. The ministry paid $19.5 billion to about 35,000 physicians in 2024-25.
The ministry said it would make better use of data analytics to flag high-risk payments, while adding the claims system was being modernized. It also said it was monitoring the impact of the $2.1-billion primary-care action plan. It also said it recognized the importance of knowing how many Ontario residents were attached to primary care and communicating that to the public.
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