Premier: Doug Ford is proud of his government's record on healthcare. "What we've done is nothing less than a miracle to our healthcare system." But Ontario's hospitals are telling a bit of a different story. Some have been taking out loans just to cover day to day costs. They say they're facing a $1 billion structural funding deficit and a looming financial crisis. They were hoping the 2026 budget would bring them some relief. And on paper, there are some big numbers: $1.1 billion in additional hospital funding for this year and $64 billion over the next decade for health infrastructure, which includes $50 billion in capital grants for hospital projects, 3000 new beds. That sounds like a lot, but will it be enough to fix the problem? Or hospitals still headed for a financial crunch? Today we're breaking down what's really going on with hospital funding in Ontario and what it means for the care you get. Welcome to The Rundown.

Right now, many Ontario hospitals are relying on bank loans to make ends meet. As of March 2025, they owed more than $66 million. And that's just one snapshot of a much bigger financial picture laid out in a recent investigation. Stacy Kuznetsova is a Toronto based journalist with the Investigative Journalism Bureau doctor. Blair Bingham is a critical care physician and a senior editor at the Investigative Journalism Bureau. Help us understand how did this investigation into hospital finances come about?

Sure. So I was working in a very busy, overwhelmed emergency department shortly after the pandemic, and I was hearing things like, oh, the hospital's in deficit. We really need to control our costs. At the same time, we were hearing that one hospital in Ontario. London Health Sciences, was in tremendous deficit, $100 million. And meanwhile, another hospital system north of where we live was shutting down an emergency department that was in Minden, Ontario. And I sort of asked myself like, like, how is this possible? Like, hospitals don't really have levers to bring in revenue, right? They get their money from the government and maybe what they're going to increase rent on Tim Hortons and charge you more for parking, but they don't have a lot of levers. And that's when we found out that some hospitals get this document called a balanced budget waiver, where they're allowed to have a deficit, but with no real plan to get out of it. And there's actually a law in Ontario, the Public Sector Accountability Act. It's been on the books since 2001, and it says 5.1 hospitals are not allowed to plan to be in deficit. Okay. And so we went after these documents. We asked hospitals for them, 44 across across the province, and most of them gave them to us. And we found out they were millions of dollars in deficit. And the ministry sort of was going to forgive them for it. Ontario health issues them, this piece of paper saying basically that they're allowed to circumvent the law and be in deficit now before 2022. This was very rare. Maybe 1 or 2 of these was issued a year. A hospital would have some particular need to spend a lot of money. But after the pandemic, it wasn't just a one off 40 hospitals, then 70 hospitals. And then in the most recent year, for which we have data ending in 2024, 85 hospitals.

And every corner of this province.

All around the province, 85. And some of them needed a balanced budget waiver multiple years in a row. And that's when we realised that we really needed to take a look at the details here and figure out what's going on with hospital finances.

All right, Stacy, help me understand because I think this is interesting when you sniff this potential problem, how did you go about finding the data? What were the methods into the research here?

For sure. This database that we've created is really a mix of publicly available documents, like audited financial statements that hospital corporations release at the end of their fiscal year. So we've looked at all of them in Ontario, 132, I believe, hospital corporations that we've reviewed for the past three fiscal years, looking at their operating deficit at the end of the year, things like bank borrowings, they had to declare. So think about this. Hospitals borrowing money from banks for short term borrowings just to stay afloat, not to build a new hospital wing, but just to cover their short term expenses. And then there was another important part of this database was documents from freedom of information legislation. So that's how we found out that the province can sometimes give hospitals money to address in-year operating pressures, none of which the public knew about.

Okay, well, let's go through the numbers. Your investigation found that 60% of hospital networks were in deficit as of March 2025, 53 hospital networks had deficits for three years running. 15 hospitals were unable to clear the debt. 85 hospitals received balanced budget waivers for 2023 2024, $218 million were given by the Ministry of Health for in-year operating pressures, 71% of hospitals had loans or lines of credit in 2425, $66 million is the amount hospitals owe banks, and $4 million in interest has been paid on lines of credit in 2024 2025. Now should mention, we reached out to the Ministry of Health for comment on these findings, but did not receive a response in time for our recording today. Neither did we. That's what I gather as well.

Blair, help me understand what stands out to you most in these numbers? There's a lot there. Yeah. What's the one that's like. You're going to make me choose. I think when we look at the money that was spent that we only found out about through a freedom of information request, which was about $200 million being given to some hospitals to kind of help cover the gap. Emergency funding, if you will. It was very unclear why one hospital would get $30 million to clear their debt, and another hospital got nothing. So we hit the pavement. We started to talk to senior leaders of hospitals, some of whom, I have to say, were outraged that their neighbour next door was getting floated when they weren't. We we probably entered this investigation thinking that hospitals needed to tighten their belt. We found out that over the last 20 years, they've trimmed all the fat they can. For the most part, there's not a lot of opportunity for a hospital to increase its revenue. And so when your next door neighbour gets $30 million, after you've made hard decisions to close down some of your ultrasound, ours shut down some of your MRI machines, not repair elevators just so that you can get by it. Really, it really irks me because it's inequitable. And there are some hospitals that the ministry is favouring, and I think that is something that no Ontarian should stand for.

And just to add to what Blair is saying, right. We found I think it's about 23 hospitals that did get this this funding to address in year operating pressures. We don't know why these hospitals were chosen for this extra funding. We don't know how this process happened. And when we asked those questions of the province, we didn't get a response.

It's very odd. And Ontario hospitals actually have to plan a budget and go ahead with it and not find out what the amount of money they're going to get from the ministry is until many months into the fiscal year. I can't think of a single company that works that way. It's very backwards, and I think a lot of hospital CEOs are so used to this that they just assume the ministry at the end of the day is going to make sure everything's okay. So if the idea here from the ministry is to increase accountability and make sure that hospital management teams are spending every penny wisely, they're not really living up to their own standard. So I think what we have is this, this fake air of accountability where the ministry is saying, oh, we're going to watch you carefully and not give you a lot of money, but then they're not living up to their own deal and being transparent with hospitals and letting them know how much they're even going to get for funding. Meanwhile, as a hospital, you know, in the emergency department, we don't control who comes in through the front door. We have no way to control expenses in that regard. People are getting older, they're getting sicker, and medicine is just getting more complicated and more expensive. Just think of some of the new cancer treatments that have come out in the last two years. It requires more hospital beds. It requires more oncologists, it requires more nurses. None of that is being funded adequately.

I want to get a better understanding of the reaction. So far to your findings, have we heard from some of the hospitals themselves? But what are members of the public saying about this?

We've heard from some people we've spoken with that the story was very welcomed. It was something that people on the inside of hospitals were talking about for quite a long time, like hospital CEOs that we've spoken with. I think even if their hospital was in deficit and in trouble, they were welcoming to the story. And that just speaks to how much more transparency this issue needs.

I imagine as someone who works in the hospital, you see this every day. But what is what is the trickle down effect? What is what are these funding shortages look like on a day to day basis?

The bottom line is that it changes the way doctors practice medicine when they're constantly being told that money is tight. We need to cut costs. I trained in the United States. I'll give you one example. So in some people who have critical brain injury, they need certain type of neurodiagnostics brain tests within hours in the states. I could get those tests done in an hour or two. Where I work now, it can take 3 or 4 days. That's for an emergency brain image. So why is this happening? It's because hospitals have very few levers to pull, but what they can pull is technician hours. They can try to save money, you know, Penny by Penny here and there. And what it means is that it changes the way we sort of tolerate the tests that we need and the timeliness with which we need them. And we see this when people need an MRI non urgently, they can wait three months, six months. That is a cost control measure. We hear about operations that get delayed because the hospital says we're not going to pay an hour of overtime to keep that operating room open just to finish the surgery. We're just going to cancel it. Hospitals are slashing wherever they can, and at the end of the day, it does affect patient care.

Let's talk a little bit of solutions from these findings. Is there something that hospitals can be doing or the province in order to sort of correct this problem?

The one answer I heard from health economists that we've spoken with was the need for long term health care planning. So, as Blair described, not year in looking for a way to balance our books at the end of this fiscal year and not knowing what happens next, not knowing how much funding hospitals are going to get. But we need a way to plan for the long term. We know that the pressures on the health system are going to increase in the next two decades dramatically. Blair is seeing it firsthand. We have more and more people who are sick and have multiple chronic illnesses, people who will require time in hospital, and we need to prepare for that inevitability. So that requires long term strategy that the government needs to be involved with.

I think to Stacy's point, all of this only matters if we're transparent about it. Throwing money at a problem without accountability is probably not going to fix the problem. Hospitals, yes, need to be held accountable. Clinicians need to be held accountable, but so does the government. You can't tell a hospital to plan a budget, a one year budget, which very few companies would ever plan for. They would always plan for three years, five years. But to do a one year budget without knowing how much money you're going to get is insane. The government needs to make sure that hospitals know what's coming to them, so that hospitals can at least plan what cuts need to be made. It needs to be done with advanced notice. Otherwise, we get this scrambling at the end of the fiscal year, some hospitals getting gifts from the government just to close out, other hospitals having to cut even further. It's not fair to anybody. It's not making sense. And I think at the end of the day, the responsibility lies with the provincial government to make sure hospitals know how much money they're going to get, so that hospitals can tell their communities, look, this is what I've got. This is what we're able to deliver with that money. We've already cut all that we can. Sure, there are bad apples, and we've seen that in a few hospitals in this province. But by and large, of 132 hospitals, about 129 of them are doing the right thing. I'm not saying cut a blank check to all the hospitals in the province, but this idea that we can just keep trimming the fat is a total fantasy, and the government needs to wake up to that.

With that being said, what do you hope Ontarians take away from your investigation? I think over the last couple of years, you know, these are a lot of numbers for people to consume. We've heard stories like hospitals and E.R. room, E.R. rooms closing in this province. What what are you hoping people take away from this investigation?

Two things I think awareness. So, as you said, we all have been in an emergency department and waited and have seen what goes on, but people don't really connect the dots there. Connect that with the funding for their local hospital. And that's what we hope the Ontario Hospital Finance Explorer, the free public database that we've built, would do for Ontarians that they can go there, look up the name of their hospital and try and figure out, you know, how healthy is my hospital financially? How much have they borrowed from a bank, how much they paid in interest, money that could have gone to patient care, but instead might have gone to interests on a line of credit for a bank. Right. And so flowing from that, we would want Ontarians to ask informed questions of the provincial government based on the information that we've made publicly available to them.

And also to hold those hospitals and the government accountable. So when you go online, you can see my government just gave Royal Bank or TD millions of dollars to stay afloat and keep the lights on. You need to be angry about that. That is money that could have gone to your parent or your child's health care. And so get angry, go to your hospital and say, this is unacceptable. Go to your MPP and say, this is unacceptable. What we're trying to do here is shed a light on the real, the real challenges that hospitals are facing, the real numbers so that Ontarians can take matters into their own hands and say, that's not enough. I want better health care than that.

Blair. Stacey, we are going to have to leave it there. But I really appreciate your time and your insights on this one. Thank you.

Thank you for having us. Thank you.

Hospitals across the province are feeling the crunch. More than 100 are forecasting year end deficits. And before this year's provincial budget, the Ontario Hospital Association said the sector was facing a $1.8 billion deficit in working capital. So did the budget move the needle? Natalie Mehra is executive director of the Ontario Health Coalition, and Doctor Otto Kapoor is an adjunct professor of emergency medicine at the University of Ottawa and member of the Public Affairs Committee at the Canadian Association of Emergency Physicians. Great to have you in studio, Otto. Great to have you on the line. Natalie, we're going to start off first, $1.1 billion promised in the Ontario budget for this next year for for hospitals to make ends meet. Does it do the job?

Well, yeah. In context, what the budget said was up to 4% increase for hospitals. So up to 4%. That could mean a lot of things. But even at 4%, it's less than what the hospitals actually need.

What do they need.

6% just to maintain essentially existing services to meet population growth and inflation and ageing pressures. The truth is that we already have a problem in hospitals, as you know, very serious staffing shortages. Too few beds left, staff did an operation or are sitting there unused because they're not staffed to be run the majority of the time. So we have all kinds of capacity that isn't being used in our public hospitals because they don't have the funding. So they're already very severely underfunded. That point that up to 4% doesn't get us out of the situation we're in, and nowhere near to where we should be. That said, we have world class hospitals. We still have amazing world class hospitals in Ontario. It's just that they're stretched too far.

All right, let's let's get your your reaction.

Well, as Natalie said, the hospital needs 6% just to keep up with the status quo. And we're talking up to 4%. But that assumes we're in a good position to start with. And we know we're not even the even the Ontario Hospital Association says we've got about $1 billion structural deficit, and we're seeing the effects of this in the emergency department, which is where, you know, the community and the hospital problems all meet at once. So we're seeing we've already been seeing the effects of hospital overcrowding, which leads to emergency overcrowding, which means leads to long waits and delays in care and sometimes, unfortunately, dangerous delays in care.

Odawa. The government has also promised $64 billion in health care funding over ten years, some allocated towards operating budgets, hospital projects, additional beds. With this begin to ease sort of the crunch that hospitals are facing.

It would begin to ease the crunch. But what I'm not hearing as much as the urgency we've been doing cutbacks, we've been doing efficiencies, we've been doing more with less for years and years. And I'm not seeing the urgency. Ten years is a very, very long time to wait for stuff that we need to have started years. Five, ten years ago.

When I asked that question, I saw you shaking your head. Does it not?

It's so frustrating. You know, this sort of down the road, we'll deal with the hospital problem. I mean, this people literally get sent home five times from the emerg without a diagnosis. People that ten, 20 years ago would have been admitted to hospital and observed, you know, had health professionals watching them and so on. So they get a diagnosis and finally get some care. We've got the frail elderly out the other end being pushed out of hospital in ways that are absolutely inhumane in the last months of their lives. I mean, this is human suffering on a scale. Like what I see now is, is just completely unacceptable in a modern country, in a modern health system. And it's so frustrating because we're literally watching money being poured into privatisation. It's not like there's no money. They are pouring millions upon millions into privatisation. They've just pushed our public hospitals into deficits on purpose to force cuts. It's cut the public, create a crisis, force privatisation. That's exactly what we're seeing.

I would imagine that the Ontario government would say that they are dealing with the current issues, with the funding that they've put. We have seen also, you know, Atul has said, you know, hospitals, emergency rooms, usually a catchall for a lot of these issues. We have seen funding for family doctors. We've seen some money for home care as well. Does that help alleviate sort of those issues as well?

Well, I mean, Ontario funds health care at the lowest rate of all the provinces and countries. So again, in context, we see funding being announced and there's a lot of PR around that. But in context, we fund all of health care at the lowest rate in Canada. We fund our hospitals dead last in Canada. Actually, I think Quebec actually just dropped beneath us, but we vie for the bottom with Quebec, and the consequences are experienced by patients. So no, there isn't enough funding and we're billions of dollars behind the other provinces. And it's not like we can't afford it. Like we're literally our province is spending billions on spas and, you know, alcohol stuff, you know, etc. but not on health care, which is a priority of people. But if we look within healthcare, there's all kinds of money, like one about $1 billion a year now being spent between hospitals and Long-Term care on For-Profit staffing agencies, 300 million just announced in the last year alone for 61 new private clinics.

All right. I want to look at sort of the finer lines here, but yeah, let's get your thoughts on their.

Yeah, I think part of the frustration from our from my point of view and for clinicians generally is that there are good solutions. We know what works. It's going to take time. It's going to take effort, but there are evidence based solutions. And what we're asking for is for that money to be invested in the solutions that we know already will work.

What are they?

And I think that's we need to we do need to do improvements in the way we deliver care that needs to be looked at. There are ways that we can improve the efficiency and productivity of what's being done in hospitals. Natalie mentioned some of them, if that we could expand the use of ORS that are currently in hospitals that aren't being used. There are other ways of looking at how are we providing elder care. Those need to be done. What I haven't seen so far is a thoughtful plan to consult with the physicians, the other caregivers, the providers to make sure that's happening. Cape can, the emergency physician Organization. We've put a lot of time into a project called empower, which says that we need to look at the various ways that we're investing in the system and that we're delivering care, and that is a way to get to a sustainable solution.

All right. Earlier in this episode, we heard from authors of an investigative report on hospital finances that they are seeking bank loans to stay afloat, to keep up with operating demands. I need to get your thoughts. Why should Ontarians be concerned about this?

I think it's outrageous. I mean, this is really what what's been happening. The provincial government will announce a certain amount of money for the hospitals. They'll hold back till the very end of the financial year, their fiscal year, and then announced a whole bunch of money, too late for the hospitals to be able to use it to hire staff and stave off layoffs or, you know, program curtailments and so on and so forth. This has happened for years running. Now, it's no way to run an army, you know, skews the military metaphor, but we need boots on the ground in the hospitals. We need it now. Staffing shortages beget staffing shortages. And because when you don't have staff there, you don't have enough people get injured. More people call in sick, more people do more overtime, and it destabilises the whole system. It also costs more. And that's what's happening. So I mean, this report, I think it's excellent. It's about time it was done. And it's shocking. So many the majority of Ontario's hospitals in deficit, you know 70% of them actually seeking loans. And we're paying as the public for interest on those loans for our public hospitals. The province has money. You know, we could be actually providing the hospitals with stable, multiyear funding if that was a political choice to do so. And instead, we're paying millions upon millions to banks and financial institutions for interest. After pushing the hospitals into crisis, completely unacceptable.

Yeah, it's a significant milestone. For years and years, we've been doing more with less and more, with less and becoming more efficient and trimming fat. And we've seen the effects of it as growing waiting waitlists and growing crowding in the emergency department with no place for us to send our admitted patients. This is, I think, a significant milestone, an event where people have to say, wait a minute, we've crossed a yet another threshold. If hospitals are relying on bank loans to stay afloat.

Abdul, I have to ask, you know, Natalie, Natalie and I have been talking, you know, she's been doing this work for quite a long time, and I want to get a better picture behind the scenes inside those emergency rooms. What is the what are the shortfalls do for patients? What are we looking at? What are you seeing in those rooms when the dollars aren't meeting the demand?

Well, what you see is patients lingering in stretchers in loud, noisy places when they should be upstairs in a bed, getting the proper care they deserve. It's not just uncomfortable. It's dangerous for the patient. We know we've known for years that spending an extra day in the emergency department instead of being upstairs doesn't just mean that you get worse care while you're there, but you have increased morbidity, you have worse outcomes, and you even have increased mortality for that hospital stay. Just from an extra day of being in the in a emergency stretcher rather than upstairs. And that's been going on for unfortunately, many, many years. And it's just been continually getting worse. And it also has effects on our staff, our morale. We're seeing emergency doctors and nurses who are who are that's not what they were went into that field to do. And they're burning out and they're leaving. And it's a spiral going downwards. Unfortunately.

If you had the ear of the government right now, what would you ask? In order to make progress in funding hospitals better in this province?

Well, I think on the funding level, Ontario normally is the average of the country. We've got the biggest population, so we usually pull the average of the country. We're dead last in funding. So they do actually have to look seriously at the funding. They need to stabilise the staff because once you stabilise the staffing, everything else kind of falls into place. The care, there's no care without staff. And of course, when you have unstable staff, you're paying a fortune up to three times per hour for, you know, agency nurses and what have you. And you've, you've made your staffing worse by, you know, more absenteeism and so on and so forth. So they've got to stabilise the staff. That applies also to home care. It applies to long term care. It applies to primary care. We should just we need to have an actual plan to stabilise the health system. Now across the system.

I'm going to give you the last word here.

I think what I think, what I'd really like to see is a thoughtful plan based on consultation, based on the evidence that we know of, what we already know works. And fundamentally, it needs levels of accountability at every level, not just at the fundamental patient clinician level, but accountability all the way up to Organization and up into the government and the ministry itself.

Well, we are going to have to leave it there. Natalie, I really appreciate your time and your insights. Thank you so much.

Thank you.

Thank you.

I'm Jeyan. Thanks for watching The Rundown. What do you want to know more about? Email us at TheRundown@TVO.org or leave a comment on YouTube. And as always, let us know what you think.