The health systems in Canada and in England have much in common. Both operate as publicly financed and administered non-profit systems, with a major emphasis placed on accessibility and universality of coverage. However, despite the obvious tendency for such health systems to converge in their approaches to healthcare delivery, the initiation of the "Internal Market" into the structure of the National Health Service (NHS) in 1991 provided the basis for introducing new thinking that challenged hospitals to become more responsive to customer service and the needs of purchasers.