The Political and Economic Sustainability of Health Care in Canada: Private-Sector Involvement in the Federal Provincial Health Care System

by Howard A. Palley, Marie-Pascale Pomey, and Owen B. Adams


"Comparative and multidimensional. ... the study carefully documents the conflicts inherent in any federal systems. This puts the U.S. federal–state challenges into perspective and means that Americans have something to learn from the experiences of the Canadian provinces ... a rare contribution to Canadians studies—a most welcome addition to scholarly works in this field. A bonus: the chapter on Quebec. It is extremely useful for teaching because there is so little written about this French-speaking province. Many studies omit Quebec because it is so hard to find material in English ... this alone makes the book extremely valuable to scholars." - Publius: The Journal of Federalism

"The American public views the Canadian healthcare system either as a socialist NHS or at best--an unending challenge to square a circle. In fact, this original universal health care system embodies the difference between political cultures of two otherwise similar countries. Through three case studies--Ontario, Quebec and Alberta--this remarkable comparative analysis sheds light on how the Canadian 'medicare', as people call it, copes with the pressures of financial sustainability. Fascinating is the discussion of how varied provincial political leaders promote an increased role for the private sector within the historical parameters of the Canada Health Act (1984), and the difficulty for Canadians to remain “objective” in discussing the private sector in health care. This publication is an authoritative study of interest for readers on both sides of the 49th parallel." – The Honorable Monique Bégin, PC, FRSC, OC (Former Canadian Minister of National Health and Welfare)

"In our era of ever increasing globalization, the perennial puzzle of providing ways for public and private interests to pull together to ensure the sustainable delivery of health care services is well reported in this excellent analysis of health systems in three Canadian provinces. The volume displays the merits of disciplined enquiry within a widely admired model for organizing, financing and delivery health care, and it adds significantly to the literature on comparative health policy at the subnational level. The book suggests lessons applicable well beyond the immediate complexity of Canada’s federalism and is a ‘must read’ for all serious advocates and practitioners of equitable sustainable health care." – Dr James Warner Björkman, Chair of the International Political Science Association’s Research Committee on Comparative Health Policy, and Professor Emeritus of Public Policy and Administration at the Institute of Social Studies, The Hague, The Netherlands

"At a time when every nation is debating how best to organize and deliver health care services, Palley, Pomey and Adams bring their expertise to clarifying privatization in health care services in Canada, with a focus on the provinces of Ontario, Quebec, and Alberta. A superb resource for students of comparative health systems. – Professor Raisa Deber, Institute of Health Policy, University of Toronto; and Director, CIHR Team in Community Care and Health Human Resources

"This book speaks to the diversity of the Canadian health system, documenting the conflicts inherent in any federal policy system. It puts the U.S. federal-state challenges into perspective. It reads like a novel--absolutely fascinating. From Alberta and Ontario to Quebec, we see the trajectories of these provinces in health care policy. Including Quebec was brilliant and it makes this book useful for teaching because there is so little published in English about this French-language first province. This book is a rare contribution to Canadians studies, a most welcome addition to scholarly work in this field and, thankfully, something I can assign to my students taking International Health Policy" – Professor Pauline Rosenau, University of Texas Health Science Center at Houston


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