2012 COMMISSION O N T H E REFORM OF ONTARIO’S PUBLIC SERVICES Public ServiceS for ontarianS: A PATH TO SUSTAINABILITY AND EXCELLENCE 2012 COMMISSION O N T H E REFORM OF ONTARIO’S PUBLIC SERVICES Public ServiceS for ontarianS: A PATH TO SUSTAINABILITY AND EXCELLENCE For electronic copies of this document, visit our website at www.fin.gov.on.ca/en/reformcommission/ © Queen’s Printer for Ontario, 2012 ISBN 978-1-4435-8896-6 (Print) ISBN 978-1-4435-8897-3 (HTML) ISBN 978-1-4435-8898-0 (PDF) Ce document est disponible en français sous le titre : Commission de réforme des services publics de l’Ontario Table of Contents Table of Contents Message from the Chair...................................................................................................................................... vii Commission Member Biographies.............................................................................................................. xi Executive Summary................................................................................................................................................. 1 Chapter 1: The Need for Strong Fiscal Action The Outlook: Three Scenarios ..................................................................................................................................70 Debt and Deficits.......................................................................................................................................................78 The Economy: How Did We Get Here?.....................................................................................................................81 The Economy: What Lies Ahead?.............................................................................................................................86 Revenue Implications................................................................................................................................................91 Spending Outlook......................................................................................................................................................96 Conclusion ..............................................................................................................................................................107 Chapter 2: The Fiscal Challenge in Context The 1990s ...............................................................................................................................................................109 Ontario: A Closer Look............................................................................................................................................113 Revenues and Expenditures: How Ontario Compares............................................................................................116 The Challenge.........................................................................................................................................................121 Chapter 3: Our Mandate and Approach The Commission’s Mandate....................................................................................................................................123 Broad Guidelines for Actions Aimed at Balancing the Budget.................................................................................124 Ambitious for Excellence: A Larger Vision ..............................................................................................................130 What Does Being the Best at Public Policy and Services Look Like?.....................................................................130 i Chapter 4: Making Transformation Work: Process and Structures Budget Planning......................................................................................................................................................136 Chapter 5: Health Background.............................................................................................................................................................145 The Cost: Now and Ahead......................................................................................................................................147 Is the Health Care System Sustainable? ................................................................................................................149 Hard Truths, Measures and Comparisons ..............................................................................................................152 What Is the Opportunity? ........................................................................................................................................167 Recommendations to Turn Problems into Realized Opportunities..........................................................................174 Fiscal Issues ...........................................................................................................................................................176 Integrating the Silos into a Health Care System......................................................................................................176 LHINs 2.0................................................................................................................................................................178 Governance and Structures ....................................................................................................................................184 Evidence-based Policy............................................................................................................................................185 Hospitals .................................................................................................................................................................187 Physicians...............................................................................................................................................................188 Community Care, Home Care and Long-Term Care...............................................................................................192 Health Promotion and Prevention ...........................................................................................................................193 Medical Schools/Training........................................................................................................................................195 Pharmaceuticals .....................................................................................................................................................195 Cost Efficiencies .....................................................................................................................................................199 Scope of Public Sector............................................................................................................................................200 Reform Process ......................................................................................................................................................200 Conclusion ..............................................................................................................................................................202 Chapter 6: Elementary and Secondary Education Historical Context and Recent Trends ....................................................................................................................203 The Current Challenge............................................................................................................................................205 Commission’s Principles and Goals........................................................................................................................207 Investments for the Future in First Nations Education ............................................................................................209 Affordability of the Full-Day Kindergarten Program.................................................................................................213 ii Table of Contents Class Sizes .............................................................................................................................................................215 Non-Teaching Staff .................................................................................................................................................218 Limits to Funded Secondary School Credits ...........................................................................................................219 Encouraging Efficient Student Transportation.........................................................................................................220 A Comprehensive Resource Plan to Live Within One Per Cent Per Year in Education..........................................222 Promoting Evidence-Based Solutions in Special Education....................................................................................225 Reform of Provincial Schools ..................................................................................................................................227 Appropriate Incentives for Teachers .......................................................................................................................228 Delivering Services More Efficiently........................................................................................................................230 Containing Costs of Retirement Benefits ................................................................................................................234