Devolution or Downloading: The Financial and Service Effects of Local Services Realignment on Ontario Ambulance Services

This paper examines the devolution of ambulance services in Ontario from provincial to municipal control to determine whether it has resulted in a more efficient, accountable, less costly, and simplified process. Data from a sample of municipalities in the province is analyzed in an attempt to determine differences in cost and service levels between municipalities that choose to contract ambulance services and those that decide to deliver ambulance services themselves. The findings reveal that although ambulance services in Ontario have been historically under-resourced and have experienced increased service levels, the cost of providing the service has almost doubled since devolution to municipalities