More Oversight of Health Spending and Pay

Summary#

• The bill creates the Transparent and Accountable Health Care Act, 2025. Its goal is to make health spending more open, especially when public money flows to private or arm’s‑length providers.

• It covers any health organization or supplier that gets at least $1 million in public funds in a year, starting with fiscal years that begin on or after April 1, 2027.

• Key changes:

  • Brings more organizations and suppliers (including for‑profit companies) under rules for executive pay, salary disclosure, and independent oversight.
  • Lets the Auditor General audit any part of their operations in years they receive $1 million or more.
  • Treats these organizations as public bodies for Ombudsman reviews, so people can file complaints.
  • Requires “Sunshine List” salary disclosures for high earners in years they receive $1 million or more.
  • Examples of covered groups include hospitals, long‑term care homes, public health units, air ambulance providers, Ontario Health and its parts, out‑of‑hospital clinics, and group purchasing organizations. Suppliers like staffing agencies, labs, IT, and cleaning firms can also be covered.

What it means for you#

• Patients and families

  • You can take complaints about covered hospitals, clinics, long‑term care homes, and certain suppliers to the Ombudsman (an independent watchdog who investigates complaints).
  • There should be more public information on how health dollars are spent, including through private contracts.

• Health care workers and high earners at covered organizations or suppliers

  • If your pay is above a set amount, your name, job title, and pay may be published on the province’s salary disclosure list in years your employer receives $1 million or more in public funds.
  • Executive pay will have to follow provincial rules and limits for broader public sector employers.

• Executives and boards

  • Executive compensation must follow the province’s executive pay framework once the $1 million threshold is met (and then continues in every following year).
  • Expect more oversight: Ombudsman investigations and possible audits by the Auditor General.

• Hospitals, long‑term care homes, clinics, and other providers

  • Crossing the $1 million public funding threshold triggers new obligations.
    • Executive compensation rules and Ombudsman oversight start the first year you cross the threshold and continue every year after.
    • Salary disclosure and Auditor General audit powers apply in each year you receive $1 million or more.
  • Applies whether you are not‑for‑profit or for‑profit, and whether the funds are grants, payments for services, purchases of goods, fees for service, loans, or loan guarantees.

• Suppliers and contractors to the health sector

  • If you receive, in total, $1 million or more in a year from covered health organizations or from other publicly funded suppliers, the same rules apply to you as above.

• Timing

  • The law takes effect on Royal Assent, but the new coverage rules start with fiscal years that begin on or after April 1, 2027.

Expenses#

• No publicly available information.

Proponents’ View#

• Shines a light on how public health dollars are used, including when money flows to private companies through contracts and subcontracts.
• Closes gaps so similar organizations play by the same rules, reducing “workarounds” that avoid oversight.
• Helps keep executive pay reasonable and focused on patient care priorities.
• Ombudsman reviews and Auditor General audits add independent checks that can catch waste or problems sooner.
• Salary disclosure builds public trust and helps taxpayers see where money goes.

Opponents’ View#

• Adds administrative work and compliance costs for hospitals, homes, clinics, and vendors, which could pull time and money from patient care.
• Public salary disclosure may raise privacy concerns and could make it harder to recruit or retain specialized staff.
• Executive pay rules may limit flexibility to attract top leaders, especially in competitive or rural markets.
• Suppliers might raise prices or avoid contracts to offset the added oversight, reducing competition.
• Oversight by multiple bodies could duplicate work or create confusion about who is responsible for what.