ABSTRACT
Given that Canada is one of the most decentralised of all federal states within the Organisation for Economic Cooperation and Development (OECD), it is noteworthy that one can discuss the idea of a discrete Canadian health care ‘system’ at all. Despite the fact that Canadian provinces have both the formal constitutional authority and considerable financial ability to determine health care systems at the level of the provinces, there has been remarkable consistency in overall health care design across all of Canada’s provinces and territories. This may, however, be changing. The first section of this chapter explains why Canada’s 13 health care systems are so homogenous notwithstanding the exceptional level of decentralisation that characterised Canadian federalism in the twentieth century. The second section explains why, despite this historical homogeneity, a far more fragmented health care landscape is emerging. The third section addresses the consequences of such a shift, and examines some of the political actions being undertaken in response.
