Governments everywhere confront major challenges to their health care programs, but federal countries must respond through systems of multi-level governance. In Health Policy and Federalism the contributors analyse the resulting complexities in decision-making in five federations: Australia, Belgium, Canada, Germany, and the United States. They highlight the impact of federal institutions and processes on key dimensions of health policy, including the balance between the public and private sectors, overall levels of health spending, the access of citizens to services, and the capacity of policy-makers to manage their systems effectively. Contributors include Keith Banting, Johan de Cock (The National Sickness and Invalidity Insurance Institute, Belgium), David C. Colby (Robert Wood Johnson Foundation), Stan Corbett, Linda Hancock (Deakin University, Australia), Antonia Maioni (McGill University), and Dietman Wassener (Universitat Augsburg).