The costs of constraint and prospects for health care reform in Canada

The sharp decline and equally sharp recovery in public health care spending in the 1990s in Canada set the stage for a broad consideration of reform options but also established hurdles to be overcome in taking action. By moving health care to the center of the federal-provincial agenda, reconfiguring the internal politics of medical and hospital groups, and heightening a public sense of the need for improvement, the legacy of the 1990s prepared the ground for reforms that would "modernize" the Canadian model. But it also yielded a degree of federal-provincial rancor and provider demands for "catch-up," which complicated the process of achieving major change.