Currently, that hospital foundation is focused on other fundraising initiatives – it recently surpassed a fundraising goal and raised well over $100,000 in its Giving Tuesday campaign to purchase nine stretchers for the Midland hospital.

As hospitals across Ontario vie for ticket buyers and millions of dollars in revenue, questions arise about how sustainable this model really is. With so much money on the line, are people buying tickets to support local health care — or simply chasing the chance at a big win?

Since launching in 2020, the Health Sciences North 50/50 lottery has become a major source of supplemental funding for the hospital, generating more than $68 million in ticket sales. Half of that revenue is paid out to jackpot winners, while roughly 35 per cent – about $23.8 million to date – has been reinvested directly into patient care, equipment, research and facility upgrades.

“Philanthropy and fundraising are critically important to the success of a health care institution in any community,” said Anthony Keating, president and CEO of Health Sciences North Foundation. “Of course, we are here to provide a high level of care to people in Northeastern Ontario and one of our biggest mandates at Health Sciences North Foundation is to ensure that people living in Northeastern Ontario have fair and equitable access to health care in the community. That is what drives our work and fundraising activities.”

Hospital foundations exist to help hospitals raise money for aspects of health care not covered by government funding, explained Keating. For example, when it comes to capital projects, a minimum of 10 per cent of construction costs has to be covered by community fundraising efforts. The community must also pay for equipment, like life-saving diagnostic tools, specialized programs and furniture.

“Recently we purchased two new MRIs for HSN,” said Keating. “The operational costs are covered by government, but equipment costs are not. That’s where the foundation steps in to raise money in the community to support those particular initiatives.”

HSN is a research and teaching institute, but the funding required for research isn’t covered by the government. “A large portion of the money we raise through the foundation, be it 50/50 or other fundraising initiatives, we also support that research and academic mandate of Health Sciences North,” said Keating.

While lotteries contribute, they are not HSN’s primary source of community-driven funding.

“We raise money in a variety of different ways, and that varies from hospital to hospital,” said Keating. “But for Health Sciences North, our lottery funds aren’t the biggest revenue generator. In fact, individual donors making financial contributions are our biggest source of revenue.”

Specifically, last year the HSN Foundation raised $12.2 million with $5.5 million through donations and fundraising, $3.4 million through the lottery and $3.1 million through net investments and other income. Further, the HSN lottery generated $11.7 in revenues, with $6.2 million going to prizes, $3.4 million in revenue for patient care, and $2 million in direct costs.

Despite other sources of community support, the 50/50 draw remains important. “Lotteries are an important part of the revenue we raise because that money is going to support those high-priority equipment needs, capital projects and investing in research that we wouldn’t be able to do without the support of the community through the lottery, but it isn’t our biggest revenue generator,” said Keating.

“Any one of those fundraising initiatives may have an ebb and a flow, and that’s why it’s really important for us as an organization to ensure we have diversified revenue streams,” he said. “If there is an ebb or flow in lottery revenue, hopefully, we see that our corporate giving will increase or our marketing strategies will increase, but we manage and monitor our fundraising activity on a day-to-day basis, which is embedded in our five-year strategic plan.”

Keating said $6 million in lottery revenue has already been reserved for HSN’s large capital expansion project that will see more beds and enhancements to pediatrics and mental health.

Health Sciences North was originally built for 429 inpatients and now has 526 beds, including 52 at the Acute and Reactivation Care Centre (ARCC), yet it cares for an average of 631 admitted patients daily, often using hallways, overflow wards and other non-clinical spaces. The hospital is undersized for the region’s needs and plans a major redevelopment.

Phase 1 will expand pediatric services, integrate mental health and addictions care, modernize the emergency department and add acute care beds, aligning with provincial health priorities to meet current and future healthcare demands in northeastern Ontario.

At the same time, the growing reliance on alternative funding methods, such as hospital lotteries, has raised concerns among health-care advocates. Natalie Mehra, executive director of the Ontario Health Coalition, said the reliance on hospital lotteries is unprecedented.

“The use of gambling to raise money for hospital equipment has now reached a whole new level,” said Mehra. “I do think it’s disturbing, and I am quite worried about it.” That’s because at one point, lotteries were used once or a few times a year, not monthly, she said.

She said that raising local funds for hospital capital or equipment faces the same challenges across the board — such as the inequities between communities and the fact that poorer areas have less capacity to generate that money.

For decades, the association has advocated for more hospital funding. “We want hospitals to do well, but this tips the scale into a kind of fundraising where questions about the ethics of encouraging people to gamble have to be raised,” she said.

When it comes to the local share, the association was never in favour of shifting increasing costs onto local communities in the first place.

“There are big wealth differences between communities and those communities that are poorer or have smaller populations, obviously, lose if the weight of raising money for the services is local,” said Mehra.

“In Ontario, approximately 88 per cent of all hospital operating revenues come from the provincial government (primarily from the Ministry of Health and Ontario Health),” said Dale. “The remainder comes from commercial services (such as retail stores or parking fees), specific patient fees (such as preferred accommodation), fundraising and donations from the community. Many hospital foundations operate fundraising lotteries as a way to generate revenues. Hospitals take great care in considering all their funding and fundraising strategies.”

“It’s often used to support clinical research, capital equipment and projects, infrastructure, and day-to-day operations, such as facility maintenance,” he said. “While hospitals must continually replace and modernize equipment to stay current, they do not receive direct government funding for capital equipment or information technology. Local fundraising plays a key role in meeting these needs.”

For hospital capital projects, the Ministry of Health typically covers 90 per cent of eligible construction costs, leaving hospitals responsible for the remaining 10 per cent — known as the “local share” — which they fund through donations, municipal contributions, and other services, he continued. Because these projects are large, the local share can be substantial.

Dale said that Ontario is facing economic uncertainty, partly due to a U.S.-initiated trade war, leading the government to limit funding for hospitals in 2025-26. Health sector spending growth is projected to slow sharply to 0.7 per cent annually, down from 6.6 per cent in previous years.

With government support constrained, hospitals increasingly rely on alternative revenue sources — and hospital lotteries, which show no signs of disappearing — are part of that strategy. Because of this, Mehra says there needs to be better guidelines. She pointed out that such lotteries often target lower- and working-class people, drawing them into gambling.

Quick facts

A closer look at where some HSN Foundation lottery revenues have gone:

· $6 million has been earmarked for the local share of the capital plan.

· $2.3 million invested in the Acute Care Reactivation Care Centre.

· $2.67 million has been invested into research to improve care for cancer care, cardiac, healthy aging, mental health and addictions, Indigenous health and more.

· $500,000 invested in renovations for radiation bunkers at Shirley and Jim Fielding Northeast Cancer Centre, serving cancer patients across Northeastern Ontario.

· $445,000 for the mobile CT unit designed to provide diagnostic imaging during surgical procedures.

· More details can be found here: hsn5050.ca/pages/impact.