In this comparative study Joan Boase traces the evolution of relationships among governments and health care interest groups in four provinces - Ontario, Quebec, Nova Scotia, and Alberta - and finds that, although they have faced similar problems, they have responded in different ways.

The author employs several theoretical approaches to explain these responses, including community/policy networks, institutionalism, and state traditions, and uses case studies to illustrate the intense interest group activity that has occurred in this sector. Boase reaches three conclusions: (1) with the development of a national health insurance plan, government actions have shifted from reliance on interest group liberalism towards concerted efforts to plan the structure of the welfare system; (2) the different systems of interest intermediation that evolved in the provinces reflect the underlying political and administrative culture and institutional structures within the provinces; and (3) the unique proactive approach taken by Ontario in the 1980s was a deliberate effort to modify the institutional arrangements through which groups had traditionally influenced policy.