The current EMS system is a comprehensive mix of different levels of government pooling funds and resources. There is some interesting history into the formation of the current state of the service, particularly who does what. This is the first of two blog posts, with the second one called “Physiology of the 911 System”. This post aims to explain how the current system is set up. The next post will explain how the system delivers its services.
Once upon a time the ambulance service was a provincial one run by the Government of Ontario Ministry of Health. Then came Mike Harris. The Conservative leader took power from the NDP’s Bob Rae and in the earlier part of the 2000s Harris commenced what has been dubbed the “common sense revolution”. How it played out became the subject of intense resistance and arguably caused more hinders versus providing benefits to the province. Essentially the government took different programs and services that fell under its different ministries to provide, and transferred (or “downloaded”) such responsibilities, and the corresponding costs for providing them to the UTMs (upper tier municipalities). A UTM is more commonly known as a region, such as Peel Region, Halton Region, Durham Region, York Region, etc.
The municipalities, enraged that the government would suddenly throw such costs at them, and then publicly announce they’ve cut costs and are saving money for the taxpayer, fought back. The regions were looking at either privatizing the service, or cutting the service altogether. Ultimately the regions and the provincial government agreed on a funding formula that ensured 50% of costs were paid by the provincial government, and 50% by the region, with control of the services under the region.
Part of the agreement is that the closest ambulance will always be used for an emergency call, even if that ambulance is not part of the region it is responding to. Also, the services of providing ambulances is heavily subsidized by OHIP, but not completely paid for. Use of an ambulance will result in a bill of $45 being sent to you. That bill can rise to $240 if your use of an ambulance is deemed medically unnecessary.
Please see this link for the complete breakdown of ambulance costs in Ontario: http://www.health.gov.on.ca/en/public/publications/ohip/amb.aspx
The actual dispatching of ambulances in Ontario has remained under direct control of the Ministry of Health and Long-Term Care. Over 20 dispatch centers are operated throughout Ontario. As it is a provincial system, no matter which dispatch center you reach you will be treated to the exact same standards, systems, protocols, and verbatim.