Regionalization organizations are essential building blocks of health restructuring and are designed to be agents of change and integration in most provinces in Canada. Yet, despite this, most citizens seem to be unaware of regional health authorities, why they exist, the drivers and constraints involved, or whether these divergent structures and regional governance processes have influenced patterns of restructuring and health outcomes. And even when discussions have taken place, these debates have tended to be more prescriptive than analytical. All of this has complicated the task of conceptualizing and making sense of the determinants that have influenced regionalization forms of health service restructuring in Canada and how these have influenced the way resources have been allocated, decisions reached and accountability exercised.