Introduction

North America has witnessed a quasi-experiment in its health care institutions over the past quarter of a century. As late as the 1960s the U.S. and Canadian health care systems were virtually identical: both spent the same amount of money on health care as a percentage of GNP and delivered their services in a similar way. By 1971 the systems' financing and decision-making processes began to diverge significantly. Canada continued to consolidate its single-payer system while the United States continued its market-oriented system.