Changes to the Canada Health Act could help address Ontario’s health system issues. Will the province be on board?

The successful implementation of the Canadian Health Act (CHA) reform due to take place in April 2026 will depend on provincial cooperation rather than competition between health-care professionals, particularly physicians and nurse practitioners.

On Jan. 10, then-Health Minister Mark Holland announced a reinterpretation of the CHA, expanding public coverage to include nurse practitioners, pharmacists and midwives. This reform arrives at a moment where the growing awareness of primary care challenges has left Canadians frustrated. Millions of Canadians remain without access to a primary care provider, emergency departments are closing, and wait times are creeping forward. The CHA reform marks a pivotal change in federal response to these challenges, but health care in the country is largely a provincial responsibility. The reform could significantly improve primary care access in Ontario. However, several key institutional structures, interest groups and competing ideas could enable or kill its success.

For years, Ontario has repeatedly attempted to tackle its primary care crisis,  most recently, committing $1.8 billion to expand primary care access and building two new medical schools to train family doctors. These efforts may seem promising, yet the CHA reform faces a major implementation threat in the province: its history of privatization. Since 1996, Ontario has quietly advanced privatization, starting with Bill 26 under the Harris government, allowing for-profit delivery of diagnostic services. In 2003, the McGuinty government attempted to allow private companies to build new hospitals in Brampton but abandoned the plan following intense public opposition. Since taking office, the Ford government has continued this privatization push – cutting OHIP-covered services, funding private surgical clinics, and expanding for-profit long-term care homes through private-sector partnerships. These policy contradictions raise uncertainty, compounded by the absence of a formal legislative amendment to the CHA to reflect the announced reforms. Further, Holland is no longer the Minister of Health, signaling a potential shift in how the reform will unfold, especially with a federal election on the horizon. Nonetheless, the ex-minister’s announcement sets a precedent, and Ontario must decide whether it will fully commit to tackling its primary care crisis or allow ambiguities to stall progress.

For years, organizations like the Registered Nurses Association of Ontario (RNAO), the Nurse Practitioners Association of Ontario (NPAO), and the Ontario Pharmacists Association (OPA) have pushed for the recognition of their roles in primary care delivery. The RNAO, for instance, has campaigned for nurse practitioners to have greater autonomy in prescribing and leading primary care teams. Similarly, both pharmacists and midwives have pushed for the authority to prescribe within their line of work. Although the scope of practice of these professionals has been expanded, their growth and integration has been stifled by the outsized influence of Ontario’s most influential medical interest group, the Ontario Medical Association (OMA). Unlike nurses and pharmacists, the OMA not only wields a significant impact in the province but also enjoys an insider status that allows it to participate in health policy processes and decision-making. In the past, the organization has lobbied against nurse practitioner education and midwifery in the province.

The new reform threatens to upend the physician-centric model of care, shifting power, authority and service delivery across other kinds of providers. This could mean family physicians may see reduced service demand as patients can access alternative primary care providers. This could also mean lower earnings for family doctors who are paid fee-for-service. While this shift could ease workloads for physicians and improve access to care, it also explains why the OMA is unlikely to accept these changes quietly.

The success of the CHA reform in Ontario depends on collaboration between health-care professionals, particularly physicians and nurse practitioners, rather than competition. Yet even though both groups agree that Ontario faces a primary care crisis, they disagree on the causes and the solutions. The NPAO attributes the issue to a lack of continuity of care and timely access to providers, with the RNAO insisting that underfunding for nurse practitioner-led clinics violates the CHA’s ban on user fees. Both groups see nurse practitioners as key solutions to addressing physician shortages, rising costs and privatization risks.

The successful implementation of the CHA reinterpretation in Ontario hinges on political will, transparency, and structural adjustments.

 Conversely, the OMA sees the crisis as an issue best solved by investing in family physicians and training more doctors. The organization continues to sound alarm over patient safety, warning that even though a need to increase access to care for patients exists, the government’s approach to addressing the issue by increasing the scope of practice for other regulated health-care providers is flawed and dangerous. The organization called the new provincial plan to let NPs replace doctors as clinical directors in long-term care homes “the opposite of common sense.” The ex-health minister’s announcement describing nurse practitioners, midwives, and pharmacists as “physician equivalent” only fuels this tension. Although the OMA has remained unusually silent on the CHA reform, its long-standing opposition to such changes suggests resistance is inevitable.

The successful implementation of the CHA reinterpretation in Ontario hinges on political will, transparency, and structural adjustments. To ensure effective implementation, the province must align its strategy with federal reforms, maintain transparency and accountability, and expand rather than limit publicly funded healthcare services. Additionally, Ontario must move away from a physician-centric governance model and establish a decision-making framework that includes core healthcare interest groups.

For interest groups, reframing the narrative is crucial. The claim that nurse practitioners are unqualified to practice is unsupported by evidence, as research consistently demonstrates that NPs provide high-quality and cost-effective care.  Limiting their role not only undermines a potentially transformative reform but also threatens Ontario’s long-term vision for integrated, team-based care. To counter resistance, the RNAO, NPAO, and OPA must coordinate efforts, leverage media engagement, and assert their role in primary care expansion.

While integrating non-physician providers can reduce costs, this potential is threatened if the scope of practice and regulations are not clearly defined. There is mixed evidence that NPs order more diagnostic tests than physicians, raising concerns about increased healthcare spending. Moreover, without clear guidelines, physicians may respond to reduced patient volumes by artificially increasing service demand to offset lost income. To prevent these unintended consequences, the Ontario government must work with regulatory colleges to establish clear practice boundaries, develop standardized payment and billing structures in collaboration with professional associations, and leverage Ontario Health Teams to monitor service use, collaboration, and cost-effectiveness. Without these considerations, the CHA reinterpretation risks being more symbolic than substantive.