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Abstract
The crisis in access to Medicare services in Atlantic Canada has long historical roots. There were clear advantages to the four provinces in the original shared-cost regime developed in the 1950s and 1960s. However, the establishment of a block transfer regime in the late 1970s and subsequent changes have disadvantaged these provinces. Efforts to better manage health spending through regional health authorities, since merged into more centralized health authorities, have not ameliorated the situation, and some policy options, including a major reform of the Canada Health Transfer, are proposed to address this crisis.
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