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The history of health care is in many ways a history of struggles for control of the work involved. These struggles have typically been highly gendered and racialised as well as class-based, with contradictory and complex consequences for both the care work and different workers. Indeed, some methods of managerial control are derived from reforms that have been fought for by workers, or have been built on their strategies. The nature and results of these struggles have changed over time and with place, shaped by global as well as local pressures. They have also changed with efforts to commodify health services, driven by profit-seeking and ideological motives, alongside management strategies introduced from the commercial sector into the organisation of healthcare work in the non-profit health services that remain. But there are real limits to the application of such strategies in health services, limits set not only by the organised resistance of healthcare workers but also by the nature of the work itself.  As in Western Europe, health care in Canada has, at least until recently, largely escaped many of the forms of managerial control developed in the for-profit industrial sector. In this essay we focus on Canada, not because it is a special case but because it provides a concrete example of processes at work in many countries, and because context matters, with each country demonstrating some unique features.