This study garnered considerable attention when it was published in November 1999 for its argument that the health care system could not be properly managed because managers and policymakers did not have access to vital information about the system’s performance. The paper also argued that if Canadians wanted to preserve the key elements of the system, and particularly a tax-financed approach that did not distribute medical care on the ability to pay, then greater private sector participation in health care provision was virtually unavoidable. Follow this link to consider the implications of this study more fully.