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The mixture of strategic purchasing and equity as themes for this volume may seem to be an uncomfortable or forced meeting between unrelated issues or, at best, a reunion of distant relatives. Historically in Canada, policies and laws directed toward equity – for example, the national Canada Health Act in 1984 or Ontario’s Commitment to the Future of Medicare Act in 2005 – have tended to be quiet on the subject of strategic purchasing and the wider range of tools that can help promote health system performance. Similarly, policies directed toward increased efficiency or quality have tended to neglect equity as one of their central or explicit goals. The Next Step on the Road to High Efficiency: Finding Common Ground between Equity and Performance