Book excerpt: Examining the changing nature of health care federalism within a competitive global context, Comparative Health Care Federalism provides a rich and nuanced account of the way in which the interplay of federal relationships impact health care within an array of systems. Complementing the theoretical and methodological objectives, this book provides a detailed, empirical description of the challenges faced by different states and the ways in which health policy-making works within each of the federal, quasi-federal, and functional federal systems presented. The authors consider what variables contribute to the formation of robust and sustainable health care systems.