A very public — and political — squabble between the city's paramedics and first responders from neighbouring municipalities is just a piece of a larger dispute between Ottawa and its rural neighbours over who pays for what in the region.

During a committee discussion on the budget this week, Ottawa city councillors asked about a damning provincial report that suggests the Ottawa paramedic service has systemic problems and had become over-reliant on rural ambulances.

What they were told by the city's lawyer is that answers would be forthcoming "later", as a provincial investigation into the matter is on-going.

But the dispute is emblematic of a much larger problem of who pays when residents from separate jurisdictions use each other's public services and infrastructure. And it's an issue that the province is just starting to tackle.

Why paramedics of Prescott-Russell are upset

It's easy to see why the paramedics of Prescott-Russell are irked by Ottawa.

Municipalities are obligated under provincial rules to send ambulances to each other's cities and towns when needed.

Ottawa paramedic chief Anthony Di Monte disputed the findings of a provincial report into ambulance sharing between Ottawa and rural municipalities. (CBC) But for the past five years, it's been the neighbouring municipalities who've helped Ottawa more than Ottawa has helped them.

In the first six months of the year, Prescott-Russell paramedics say Ottawa dispatchers called them 360 more times than their municipality relied on Ottawa ambulances. Apparently, those numbers have only worsened in the last half of 2016.

In each of the last five years, Ottawa has had to shell out every year to four surrounding jurisdictions for their paramedic help to our city, and three times in the last five years to Lanark County.

In 2015, Ottawa paid Prescott-Russell alone more than $84,000 for the use of their ambulances.

Deal between municipalities ended in 2015

But back in 2008, the province decided that municipalities no longer had to pay each other for extra paramedic assistance.

The Ontario government picks up half the tab for paramedic services (including in Ottawa), and presumably assumed that figuring out who owes what to whom wouldn't be worth the trouble.

And so when Ottawa's long-term contract with other municipalities expired in 2015, the city didn't renew it.

Ever since, the chiefs of Renfrew, Cornwall, Lanark and Leeds-Grenville, and Prescott-Russell have been trying to get a new deal with the city.

So far, no dice.

Frustrated by the seemingly growing number of calls — coupled with the city's unwillingness to pay for them — Prescott-Russell filed a complaint with the province about a specific night last August when Ottawa called their paramedics for help 13 times.

It's a damning report, although Ottawa's paramedics are disputing the findings. While it's still under "investigation", city officials aren't commenting further on whether Ottawa's paramedic system needs an overhaul, other than to say that adding 24 paramedics and five ambulances to the service in 2017 should help alleviate the city's dependence on outside first responders.

Bigger issue than just paramedics

The disagreement between paramedic services will need to be sorted out over coming weeks, but it points to a much larger problem that our leaders haven't really dealt with head on: how to get outsiders to pay for public services they use regularly.

Ottawa councillors have argued their taxpayers are subsidizing people outside the city who use the infrastructure but don't pay for it. (Kate Porter/CBC) Prescott-Russell (and other surrounding counties) may be getting the short end of the stick when it comes to paramedic services, but in most other ways, it's residents outside of Ottawa who benefit from using the city's infrastructure without contributing to them.

This is particularly true when it comes to moving people around.

Residents from outside Ottawa regularly leave their cars at the city's park-and-rides (mostly for free). Sure, they pay the OC Transpo fare, but these fine folks don't pay the taxes that Ottawa urbanites do to operate the transit system. In 2017, for example, 54 per cent of OC Transpo's operating budget will be covered by property taxes — taxes that no one from Russell or Rockland or Kemptville paid.

And if those commuters bought new homes outside the city limits, they didn't pay the development charges that help fund new infrastructure.

The same goes for roads. Commuters into Ottawa enjoy our infrastructure without having to pay for it.

That doesn't mean that paramedic services in surrounding areas should necessarily be on the hook for that imbalance, but somebody needs to deal with it.

Province starting to address imbalance

And the provincial government appears to be doing just that, albeit slowly.

In June 2014, Cumberland Coun. Stephen Blais successfully moved a motion asking the province to start a "Places to Grow" exercise for Eastern Ontario. The Liberal government earmarked money for this in its 2015 budget, and earlier this year, a consultant interviewed 24 mayors, wardens and chief administrative officers of 24 upper- and single-tier municipalities.

We don't know what they said yet, or when the province might come up with a plan to address some of the inequalities of who pays for regional growth, or how municipalities can collaborate more fairly.

It won't be easy. Ottawa will contend its residents are unfairly subsidizing its neighbours, while adjacent municipalities are likely to argue that Ottawa is trying to stifle growth outside city boundaries.

But the province needs to find a solution soon.

Ottawa is spending $2 billion of its own (or, more accurately, city taxpayer) money to build an LRT system that promises to bring light rail to the far reaches of Ottawa by 2023. (Well, not in Kanata, but that's another story).

Ottawa is even planning to widen Highway 174 in the east end to accommodate car-poolers and buses specifically to get out-of-towners to the new Trim Road LRT station.

So shouldn't we find a way for our neighbours, who are sharing these expensive services, to pay for a bit of them?