| Chapter 1: | Examining Provincial Variability |
public oversight and management of the health care delivery system. Although the CHA principles apply only to coverage of necessary hospital and physician services, the act also provides federal contributions for a list of extended health care services that provinces and territories may choose to cover. Insurance (primarily obtained through employment) also plays an important role in funding dental care, ambulance services, pharmaceuticals, vision care, and professional services other than those provided by physicians (Evans 2009).
Introduction
This study examines the recent development of public–private sector relationships, focusing particularly on the for-profit sector, in provincial health care systems in Ontario, Quebec, and Alberta. Ontario and Quebec are Canada’s two most populous provinces, and they differ widely in language, political culture, and political history with respect to health care. Alberta is a prairie state with an increasing population, unique among provinces because of its long-term governance by the Progressive Conservative Party and before that, by the Social Credit Party. Political rhetoric in Alberta has emphasized a business model as the most efficient approach to the delivery of health care services. Use of the word delivery in this study refers to the organization and management of health care, as well as to the physical provision of services (Deber 2002). This study also examines the factors underlying varied provincial dispositions to act regarding public–private sector initiatives (Blank and Burau 2004; Heisler and Peters 1977; Nathanson 2007).
Three factors that we touch upon in our analysis are (a) the levels of government and the nature of their involvement in public policy concerning the provincial health care delivery systems (in Canada, the provincial–federal relationship is particularly relevant), (b) the nature and characteristics of public and private sector activities developed within provincial health care delivery systems, and (c) factors influencing provincial