Canada has a complex health delivery system which is a conglomeration of 13 public plans--10 provincial and three territorial as well as a number of federally administered plans serving special populations such as Aboriginals and Veterans--all providing full coverage for most hospital and physician services as well as partial coverage for many services that vary among plans. The importance of this study is that it examines how the public/private sector relationship in health care delivery--particularly that of the for-profit sector--has developed both historically and in recent years, in three subnational provincial jurisdictions within a federal system. The case study provinces are Ontario, Quebec, and Alberta. The study examines both similarities and differences in this development. These provinces are highly distinct in their political culture and political history affecting health care delivery. Ontario and Quebec are Canada's most populous provinces and Alberta is an increasingly populous prairie state. Alberta is unique in its long-time governance of the Progressive Conservative party and its predecessor the Social Credit Party. Ontario has had a more variable political history with periods of Progressive Conservative, New Democratic Party and Liberal leadership and in recent years Quebec governance has shifted between the Parti Qu becois and the Liberal Party. In this study, one dimension that the authors examine are political dispositions to act regarding public/private initiatives in health care delivery and how this affects health care delivery in these provinces. 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. However for other extended health care and health care-related services, there are federal contributions that are not constrained by these principles--although subject to reporting obligations. 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 which is discussed in the case studies. In the provincial case studies, the authors examine how the federal/provincial dynamic in the delivery of health care services has worked out in the three provinces, with respect to similarities and differences regarding the involvement of the for-profit sector both within and outside the respective Medicare systems. They also examine how the fiscal setting has affected both political and economic sustainability pressures with respect to inclusion of private commercial initiatives in these three provincial settings. The authors note that these initiatives occur both within and external to Canadian provincial Medicare systems and that there is a need to see that such initiatives are held publicly accountability to meet equity and access goals. The study utilizes government documents, press reports and personal interviews to draw a picture of health delivery developments within the Canadian federal context. This study adds to the comparative health policy literature by applying a comparative approach to subnational provincial cases. It is also noteworthy to note that globally, many nations' health insurance plans incorporate a mixed public and private health delivery system, albeit that the mixes of for-profit and not-for-profit organizations will vary with respect to the ideological, political, cultural and historical characteristics of various nations. This is an important book for collections in Canadian studies, political science, and public health.

Private for-profit activities in the health care sector in Canadian provinces have moderately shrunk the definition of "necessary medical and hospital services" that must be provided under conditions of public administration. "Necessary health care services" that include all necessary hospital services, physician services and surgical dental services must also be provided without copayments or user fees - or the provinces in violation would be subject to financial penalties by the federal government. (Also such extensions have occurred among other "extended" health care services such as diagnostic imaging and in-home as well as long-term care facility services not subject to the same restrictions.) A number of Canadian health policy analysts have contended that economic factors are not involved in decisions to reduce the notion of "necessary services" but rather that political sustainability is the driving factor in these decisions (Boychuk, 2004; Evans, 2004; Flood, Stabile & Tuohy, 2008). We maintain that the development of new technologies (Berenson & Abelson, 2008; Fleury, 2008), pharmaceutical innovations, competing (non-health) demands on the federal dollar and some factors related to an aging population, together create an environment where economic, as well as political sustainability drivers are leading to some peripheral erosion with regard to the basket of necessary medical and hospital services in Canada's provincial health care delivery systems (Yakabuski, 2004), as well as the extension of commercial enterprises in the extended care area. Our presentation will examine the distinct governmental, linguistic, religio/cultural background as well as the distinctive political process, political symbolism and ideologies, and political differences that exist in the three provinces of Alberta, Ontario, and Quebec. After discussing these differences in some depth, we conclude that a combination of political and economic sustainability factors have led to increased growth of for-profit private enterprises at the margins of the Canadian provincial health systems and usually in a manner that integrates or relates these operations into the framework of Canada's public health insurance and the health care programs in the three provinces of Alberta, Ontario and Quebec. Furthermore, we conclude that essentially this growth is related to maintaining the public health insurance in Canada in an atmosphere of increasing financial demands on public revenues both within and outside of the arena of health care.

Current tensions in intergovernmental fiscal arrangements are thus important impediment to improving the health care system. At the same time, the failure of provinces to correct health care problems acts a serious irritant in intergovernmental relations, creating a vicious cycle where deficiencies in intergovernmental fiscal relations make health care reform difficult while failures to effect health care reform increase conflict between the provinces and the federal government. This collection of essays analyses key issues in federal-provincial health care relations, particularly the fiscal component. The authors look at why there is a role for the federal government in health care and consider the critical issues in recent intergovernmental political battles over this role. The issues of whether the vertical federal-provincial fiscal imbalance is myth or reality, how much the federal government does and should contribute financially to provincial health care programs, and methods for settling disputes, such as those over user fees, are discussed. The authors also provide concrete proposals for reconstructing the federal-provincial partnership. Contributors include Keith Banting (Queen's University), Robin Boadway (Queen's University), David Cameron (University of Toronto), Harvey Lazar, Jennifer McCrea-Logie, France St-Hilaire, and Jean-François Tremblay.

Since the start of the twenty-first century, Canadian provinces have increasingly begun turning to the private sector to finance and construct large-scale infrastructure projects. From a critical public policy perspective, the danger of these public-private partnerships (P3s) is that they are more than just new ways to deliver public infrastructure. They are neoliberal projects that privatize and corporatize the basis of public services. Analyzing four Canadian P3 hospital projects, Heather Whiteside argues that P3s not only fail to fulfill the promises made by their proponents but also compromise public control of health policy, outcomes, and future plans. Yet, despite these disadvantages, the use of P3s is being normalized and expanded in BC and Ontario through capital planning frameworks and special government agencies that support and encourage P3 projects. Based on extensive interviews with academic experts, union representatives, provincial government decision-makers, and private sector partners, Purchase for Profit will be important for those studying public policy in any of the areas in which P3s are now being adopted.

"The ongoing COVID-19 pandemic marks the most significant, singular global disruption since World War II, with health, economic, political, and security implications that will ripple for years to come." -Global Trends 2040 (2021) Global Trends 2040-A More Contested World (2021), released by the US National Intelligence Council, is the latest report in its series of reports starting in 1997 about megatrends and the world's future. This report, strongly influenced by the COVID-19 pandemic, paints a bleak picture of the future and describes a contested, fragmented and turbulent world. It specifically discusses the four main trends that will shape tomorrow's world: - Demographics-by 2040, 1.4 billion people will be added mostly in Africa and South Asia. - Economics-increased government debt and concentrated economic power will escalate problems for the poor and middleclass. - Climate-a hotter world will increase water, food, and health insecurity. - Technology-the emergence of new technologies could both solve and cause problems for human life. Students of trends, policymakers, entrepreneurs, academics, journalists and anyone eager for a glimpse into the next decades, will find this report, with colored graphs, essential reading.

Caring For Profit traces how Canada's $77 billion a year health care industry is turning away from its original mandate of providing the best possible medical care to Canadians, and how multinational capital is forcing its way into our non'profit health care system. In Caring For Profit, Colleen Fuller traces alliances that were struck between private insurers and the medical profession during the 1950s and 1960s to defeat "socialized medicine". These alliances survived the establishment of medicare in Canada in 1968, and have been strengthened by new forces emerging in an era of globalization. Instead of a health care system focused on providing the highest quality of care to the greatest number of Canadians, the system is increasingly dominated by financial giants more concerned with consolidations, mergers, acquisitions, and higher profit margins. Caring for Profit is a "who's who" of key people and corporations making money in Canada's health care sector ? and a portrait of the strategies and alliances that threaten to replace the principles of medicare with the dictates of the stock market.

An examination of trends towards increasing state-society partnerships and intergovernmental collaboration in the face of global economic restructuring.