Canada’s provincial health-care systems have long suffered from a policy-driven confluence of high spending and poor performance. While some provinces have attempted minor reforms, all have largely remained committed to the status quo of monopolistic health care dominated by government. This lack of provincial policy innovation is at least partly driven by the federal government’s involvement in provincial policy making through the Canada Health Act and substantial cash transfers tied to provincial compliance.

This federal constraint on provincial experimentation must be reformed to free up provinces to explore proven approaches to delivering universally accessible health care.