In the late 1990s several policy issues concerning the Canadian public health care system became the subject of public debate in Canada. These included the rising costs of the system, including cost per capita; which level of government should bear rising costs; whether and what forms of privatization should be introduced; delays in receiving treatment; the quality of treatment; differences in access to treatments in different provinces (so-called "uneven coverage"); and the extent to which health care service delivery was disaggregated.
Participatory decentralization is the process of handing out legitimate political authority to the citizens. It contributes to democratization by bringing the government ‘closer to the people’, imparting the citizens with political knowledge through their participation in local management, and making the government more accountable. 
This case study features a referendum on a controversial viaduct in Antwerp, Belgium. The construction of this viaduct was highly troubled and costly from the beginning, attracting heavy criticism from multiple groups. A referendum ultimately rejected plans to build the unpopular bridge, instead replacing it with a series of tunnels.
This case study was written by Sandy Heierbacher, Director of the National Coalition for Dialogue & Deliberation (NCDD), in 2001 as part of a consultancy with the Center for Disease Control's National Immunization Program.