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Past experience suggests that in the discussions over a new health accord, the provinces will say that if the federal government agrees to transfer more money for health, they will take action to address these problems. For a new federal government looking to set a new pattern in federal-provincial relations and to leave its mark on health policy, this could sound like an attractive proposition, but it should be resisted.

The main obstacle preventing substantive health-care reform in Canada is not a lack of money, but the inability of provincial governments to stand up against the various interest group

The main obstacle preventing substantive health-care reform in Canada is not a lack of money, but the inability of provincial governments to stand up against the various interest groups (including labour groups and private corporations) that want to protect the status quo. If provincial politicians can deflect the blame for their inaction to the federal government, they are less likely to push through reforms that are opposed by these vested interests.

Even if the data on our health system’s performance is not encouraging, promising experiments with methods to improve it are going on in a number of provinces. Rather than imposing national strategies for seniors, drugs and other things, the federal government could play a valuable leadership role by advocating core principles, while encouraging diverse implementation strategies.

When the OECD and Commonwealth Fund results are broken down at the provincial level, some provinces are clearly doing things better than others. Even if one is not able to identify the specific reasons why some do better than others, it is clear that Canadian provinces still have plenty to learn from each other about how health care can be organized and delivered effectively.