The governance of healthcare systems is inherently complex and often leads to recurring debates about the advantages and pitfalls of centralization and decentralization to address politicization in healthcare. The international experience provides insights to reflect on the analysis of the recent reforms in the Canadian context, such as the one by Jean-Louis Denis. In this commentary, we argue that creating massive structures to shield operational management from political interference generates challenges related to the multilevel nature of decision making and the re-creation of siloes. Hybrid approaches may provide checks and balances and achieve the objectives of both centralization and devolution.

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