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There is increased focus, both in Canada and§internationally, on the processes by which health§care resources are allocated. This study examines a§set of resource allocation decisions to determine how§these decisions are currently being made. §Specifically, the project examines how decisions§involving endovascular coiling, MRIs, and powered§upper limb prostheses are made in three Canadian§provinces: Alberta, Newfoundland, and Saskatchewan. §The project found that because the processes for§allocating resources are often developed through and§in response to the unique history and culture of the§institutions in question, it is difficult to develop§decision aids that are applicable over a wide range§of sites. Maintaining established and familiar§processes, even those not consistent with the types§of decision aids recommended in the academic§literature, may be the most efficient way of§allocating resources for many organizations. The§main implication of these conclusions is that§improving the processes for allocating health care §resources will likely require more institutionally-§specific and area-of-care-specific reforms.