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Ernst & Young didn’t really conclude that. The growth in spending on internal government operations has been almost zero for 15 years, the consultants found.

Ontario has been spending more on services, though. Health care, education, and economic development are the biggies. Almost all that spending — 99.8 per cent of spending increases, after inflation is factored out — is in transfers to hospitals, doctors, universities, colleges and school boards, whose behaviour the government doesn’t control directly.

If the province wants better outcomes, or the same outcomes for cheaper, it’ll have to fundamentally change the way it funds these institutions, Ernst & Young says.

“The opportunity for Ontario is to engage in a comprehensive review of its various funding models and to introduce the notion of an ‘efficient price’ for services in as many cases as possible,” it says.

So hospitals might get $10,000 for replacing a knee. Elementary schools $5,000 to educate a second-grader for a year. We’d let them figure out whether they can do it for less.

In practice, this is really, really hard. Is $10,000 for a knee replacement an equally fair price in Ottawa, Toronto and Kenora? Can I set up my own private clinic for only knee jobs? What if the second-grader has dyslexia, or uses a wheelchair, or speaks neither English nor French? Will we pay the $5,000 to a madrassah as happily as we will to Berrigan Elementary School?

At the same time as it proposes delivering public services by having local agencies compete to become more productive, the Ernst & Young report proposes centralizing other government functions for efficiency.