Policy Brief
Today, children registered with AccessOAP wait, sometimes for years, for an "invitation" issued by registration date. In a working SEM, a child whose Determination of Needs is complete is matched to the next available qualified provider in their region as soon as that capacity exists. This eliminates the administrative delay between "you can be served" and "you are being served."
Today, families select a provider after their funding invitation, and discover the provider has its own wait. In a working SEM, all providers in a region share a single capacity pool. The constraint shifts from chronological invitation order to actual delivery capacity. The Saskatchewan Surgical Initiative made exactly this shift; results: 75% wait reduction.
Pooled matching alone moves the bottleneck, without provider capacity, families are still rationed. The FAO has noted the OAP requires significant workforce expansion. Direct workforce funding: BCBA training pipelines, RBT certification subsidies, university-affiliated programs (McMaster, Western, U of T), incentives for rural practice. Treat workforce as part of the structural reform, not an afterthought.
Single-Entry Model variants have produced measured wait-time reductions across multiple healthcare service categories. The OAP architecture would be applying techniques with documented effectiveness, not experimenting in a new domain.
| Program | Period | Documented result | Mechanism |
|---|---|---|---|
| Saskatchewan Surgical Initiative | 2010-2014 | 75% reduction in patients waiting >3 months (15,352 → 3,824) | Centralized registries + pooled referrals + capacity expansion |
| Vancouver OASIS | Ongoing | Significant osteoarthritis wait reduction | Single-Entry Model for orthopaedic referrals |
| Winnipeg Central Intake | Ongoing | Reduced specialty-referral waits | Pooled specialty-referral intake |
| UK NHS Physiotherapy SEM | 2000s | Average wait 16 weeks → 4 weeks; non-attendance 18% → 2% | Centralized referral intake with patient choice |
| NHS England 18-Week Target | 2008 | Achieved 18-week max referral-to-treatment | Funding boosts + targets + performance management |
| Ontario Rehab Wait Strategy | 2010s | Improved client throughput | Acuity prioritization + self-management education + audits (85% sites) |
A Single-Entry Model reduces friction. It does not create new funding. The FAO 2020 analysis found that serving all registered children at 2018-19 service levels would require $1.35B/year. The 2026-27 OAP budget is $965M. The annual shortfall is $385M.
Even an optimally-implemented SEM cannot deliver care that is not funded. The structural reform (SEM) and the fiscal reform (close the $385M gap) are complementary. Both are needed. SEM is achievable without new appropriations and can begin immediately. The fiscal gap requires sustained budget commitment over multiple cycles.
See Cost to Clear the Waitlist for the fiscal-reform analysis.
Design phase. Convene a working group with AccessOAP, MCCSS, FAO, OAC, ARCH, A4A, and provider representatives. Specify pooled-matching algorithm; define provider capacity reporting. Workforce expansion plan begins.
Pilot phase. Implement pooled matching in 1-2 regions (e.g., Eastern Ontario + a Northern region). Compare wait times to control regions. Refine based on data.
Provincial rollout. Scale pooled matching to all regions. Workforce expansion produces first new BCBA/RBT cohorts.
Measurement & refinement. Public quarterly reporting on wait times, capacity, and outcomes. Performance management against targets (analogous to NHS 18-week target). External audit of the pooled-matching system to ensure equitable access.
Written by Spencer Carroll
Founder & Autism Advocate
Evidence on this page
Key claims are paired with their source, evidence tier, and verification date so readers can inspect the public record directly.