systems. Finally, we raise the concern that in order to meet the public need for access to health care services and to quality care in this environment, a regulatory process is necessary to provide for public accountability.
Canada’s complex health care delivery system is a conglomeration of more than thirteen public plans, all providing full coverage for most hospital and physician services, as well as partial coverage for many services that vary from plan to plan. This study examines the development of the public–private sector relationship in health care delivery—particularly that of the for-profit sector—both historically and in recent years, in three subnational provincial jurisdictions within a federal system, examining both similarities and differences. The case study provinces demonstrate contrasts in their political cultures and political histories vis-à-vis health care delivery. Ontario and Quebec are Canada’s most populous provinces, and Alberta is a prairie state with an increasing population. Alberta has long been governed by the Progressive Conservative Party and its predecessor, the Social Credit Party. Ontario has had a more variable political history, witnessing periods of Progressive Conservative, New Democratic, and Liberal leadership, and in recent years Quebec governance has shifted between the Parti Québécois and the Liberal Party.
Provincial medical and hospital plans are constrained by the Canada Health Act of 1984. For necessary medical and hospital services, the provinces and territories must adhere to the five principles of the act in order to receive federal funding. For such services, first-dollar coverage is required. However, other extended health care and health care–related services are covered by federal contributions that are not constrained by these principles. Another factor providing some flexibility in provincial medicare plans is that necessary hospital and medical services are not enumerated in the Canada Health Act. This has allowed some “delisting” of services, a phenomenon discussed in the case studies.
The three case studies examine how the federal–provincial dynamic in the delivery of health care services has worked out in the three provinces, exploring similarities and differences regarding the involvement of the