Bundled payments are often proposed to improve surgical care value by shifting financial risk from payers to providers. While they may generate savings, evidence from international programs and Ontario shows mixed cost effects and modest utilization changes. They are also not a substitute for the capacity reforms needed to address Canada's surgical backlogs. Key implementation challenges – including selecting participating teams, building analytic and data infrastructure to evaluate proposals and set prices, designing shared-savings arrangements and aligning incentives within multidisciplinary teams – cannot be overlooked. Without careful design and piloting, bundled payments risk limited savings and unintended consequences.

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