The annual report of the auditor general is, for Queen’s Park reporters, an end-of-year tradition as sacred as carolling and eggnog. It is not generally a gift for the government: hundreds of pages of findings in the “performance audit” section reliably showcase examples of wasted public dollars or, at a minimum, a lack of clear oversight and accountability. This year’s report from auditor Shelley Spence focuses on health-care spending in particular — the single largest area of provincial spending, and the one that’s growing fastest. From primary care to doctor education to even the procurement of personal protective equipment, Spence’s report finds numerous areas where the government either can’t show its work or is just obviously getting things wrong.
Perhaps the most howl-worthy detail in this year’s report is related to PPE. In the heat of the COVID pandemic, as governments across the world were scrambling to secure supplies of personal protective equipment, Ontario created Supply Ontario, an agency tasked with ensuring we’d never again be left high and dry.
So how are things going? Not great! While the province signed long-term contracts to ensure a consistent supply of PPE, actors in the health-care sector (most notably hospitals) aren’t required or even interested in using the provincial inventory — they’ve got their own suppliers. Other provinces have solved this problem by making their comparable agencies the sole purchaser for the hospital sector; Ontario apparently needs to reinvent the wheel at least one more time.
The audit notes that Supply Ontario has had to write off $1.4 billion in inventory since its inception due to “age, damage or obsolescence,” and that’s despite some inept efforts to offload goods into the health-care sector, including hand sanitizer that contained less alcohol than Public Health Ontario’s best practice. Put it all together, and Supply Ontario’s inventory is expiring from disuse faster than it’s being used.
Supply Ontario is a relatively recent creation that could reasonably be excused for having some growing pains. Not so the province’s billing system for doctors, which continues to lack some basic safeguards to ensure the public isn’t getting hosed. Despite doctor billing scandals going back a decade, OHIP continues to lack a consistent way of alerting the ministry of health when a doctor bills the province for unusual amounts, such as claiming to have worked 365 days a year. The province does claim to have found and recovered $8.1 million from 2022 to 2025 in inappropriate billings, but the auditor notes that the government’s strategy is entirely reactive, relying overwhelmingly on tips from the public and not a more robust internal process.
Maybe that roughly $2 million annually is all the fraud that exists in OHIP’s billing. But payments to physicians amount to $20 billion annually, which would make dollars to doctors the third largest ministry on its own, after the rest of the health-care system and all of education. Of that, $13.3 billion is under the traditional “fee for service” billing model, and the government’s own estimate is that as much as five per cent of FFS billing might be problematic, amounting to $665 million in cash lost to taxpayers that could have been spent otherwise.
And it’s not like there’s a shortage of priorities the government could spend that money on, including the basics. Speaking of, the government says 1.3 million people lack access to primary care; Spence draws on other research suggesting that number is more likely 2 million. The government is genuinely spending large sums to try and recruit family doctors, but the shortage is so severe that municipalities are spending millions of their own dollars to try and attract talent — raising the possibility of duplication or a beggar-they-neighbour race between local governments. Meanwhile, the online service the province created in 2009 to help people connect to primary care is no longer “fit for purpose” according to the sector and doesn’t reflect an increasingly diverse provincial population (it only provides assistance in English and French.)
One of the more notable things about this year’s annual report is how relatively tightly focused it is. There’s a chapter about the province’s recycling programs, but otherwise all of the major performance audits are focused on health care. Some years the annual report reads more like a shopping list; this year’s report has a much clearer and coherent structure. Each model has its pros and cons — Ontario is a big place, and its government does a lot of different things, and some years a report like this is necessarily going to include a diverse range of topics. This year’s report shows that when you need to criticize the government (as the auditor general must, almost by definition), sometimes a scalpel can be as useful as a shotgun.
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