Regionalization: are even the flaws quintessentially Canadian?

Lewis and Kouri's analysis of the Canadian experience of regionalization resonates strongly with the Australian experience, but Australia lacks a clear trend. Rather, there is a record of oscillation in the system between consolidation "at state level" and devolution "to regions or networks", although there is a general movement away from atomization "that is, stand-alone hospitals and health services". This paper briefly reviews the Australian situation, and then focuses on the differences in our two countries' regionalization experiences. I argue that two Australian problems "the federal/state split and the struggle for control" have led to different outcomes, and they throw a different light on the basic question posed by Lewis and Kouri: How might regionalization better contribute to health system goals? This paper is written from the perspective of a participant in Australia's regionalization process--most recently as chair of the governance and funding task group of a comprehensive health system review in South Australia, one of Australia's eight states and territories. The task group recommendation to regionalize the system "Generational Health Review 2003" was accepted, and the changes come into force in July 2004. This looks like being the last devolution in the Australian system for some time.