By April 1, provinces were expected to have a policy in place to publicly fund all medically necessary services delivered by nurse practitioners when those services match what a physician would provide. Ontario will not meet that date. The province will not face federal penalties until April 2027, but seniors are already paying the price, sometimes literally, through clinic memberships and visit fees.
Nurse practitioners can assess, diagnose, order and interpret tests, and prescribe treatment. They work in family health teams, community health centres, hospitals, long-term care homes and in more than two dozen nurse practitioner led clinics. Two years ago, private subscription clinics began spreading, with membership models like the Kingston clinic that charges about 1,800 dollars a year for primary care. That clinic’s founders had first applied to operate as a publicly funded team and were turned down.
Ontario once pressed hard to close what was called a loophole that let these clinics bill patients for primary care. Now, after the federal clarification that nurse practitioner services equivalent to physician care must be publicly funded, the province is stepping back from urgency. Critics, including Ontario Liberal health critic Dr. Adil Shamji, have called that delay hypocritical and warned that it keeps the door open to out of pocket primary care.
This perspective draws on three kinds of evidence and experience:
Reported facts on Ontario’s decision not to have a funding policy in place by April 1, the federal deadline, and on penalties for non-compliance beginning in April 2027.
Descriptions of current conditions: nurse practitioners mainly paid by salary, higher pay in hospitals, subscription clinics charging annual primary care fees, and ongoing challenges with recruiting into publicly funded primary care settings.
Interpretive recommendations that flow from those facts: using flexible funding models, similar to family doctors’ fee-for-service or per-patient enrolment, and prioritizing seniors and rural communities when expanding positions.
What often gets missed is the way funding rules quietly decide who is actually seen. When hospitals pay more, nurse practitioners are pulled away from community settings, and the seniors who most need consistent primary care in their neighbourhoods are left behind. Underfunded models push some providers toward private membership clinics, so only those who can afford fees get timely care.
Ontario public health policy can choose a different path. In the short term, the province can commit that any medically necessary nurse practitioner visit for a service already covered when delivered by a physician will be publicly paid, including in communities where seniors are now turning to subscription clinics. Over the next few years, Ontario can roll out flexible funding for nurse practitioners, modeled on the options available to family doctors, while tying new positions to seniors, home care and rural and remote regions.
How nurse practitioners are funded has become a quiet test of whether Ontario still believes in universal primary care for older adults. Seniors have already done their part for this province. Public policy should do its part for them.
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This article was created using research from the cited references below, a human editor and an AI-assisted workflow.