An estimated 600,000 surgeries are performed in Ontario each year, with over 250,000 Ontarians on wait lists—tens of thousands of whom are waiting on orthopedic procedures, including shoulder surgeries like rotator cuff repair, shoulder replacement, and labral repair.
All medically necessary shoulder surgeries are delivered through the publicly funded Ontario Health Insurance Plan (OHIP), because private surgical options in Ontario are restricted. Ontario surgeons may not accept payment for medically necessary shoulder surgery from Ontario residents.
Unlike most provinces, Ontario effectively prevents its surgeons from "opting out" of OHIP, which would otherwise allow them to see Ontario residents privately within the province. Accordingly, Greater Toronto residents interested in private-pay shoulder surgery must travel out-of-province for any medically necessary procedure.
Private pay for purely elective surgeries (e.g. cosmetic procedures, LASIK) is permitted under current regulations.
Current regulations: Ontario maintains some of the stricter regulations around private surgery in Canada. The Commitment to the Future of Medicare Act (CFMA) prohibits physicians from charging patients for OHIP-insured services, and enforcement has historically been rigorous. Unlike BC, QC, or AB, Ontario has seen less legal challenge to these restrictions, and the private shoulder surgical landscape remains more constrained.
