There is consensus that the Canadian health system needs to be reformed and that we are failing to achieve this objective (Romanow 2002; The Standing Senate Committee on Social Affairs Science and Technology 2002; Harvey et al. 2013; Lewis 2015). The authors provide a refreshing perspective on how this could be accomplished: a new model for conditional federal investment that is linked to quality, efficiency and outcomes; incentives for improvement that don't invoke dysfunctional competition; and a national system of outcome measurement. It is a well-reasoned and thoughtful set of solutions that could fit with the complex multi-jurisdictional character of Canadian healthcare. The key will be how to get there.

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