This study maps where resource allocation decisions are made (Ministry of Health, Regional Health Authority or local provider) and who is involved (experts, providers, consumers) across four Canadian provinces. In particular, decision-making around which particular goods/services are publicly paid for are studied in the following 9 sub-sectors: physician services, hospital services, drug benefits, diagnostic testing, assistive devices, home care, long-term care, public health and out of province benefits.Methods. Information was gathered through a combination of key informant interviews, a review of the literature and a review of relevant legislative, regulatory and policy documents.Results. There is considerable variation across sub-sectors and across provinces in both their use of advisory bodies, and the extent to which local decisions are constrained by national and sub-national policies. This variability appears related to the presence of institutional rules (particularly the Canada Health Act) and the strength of provider stakeholders.