Lewis and Kouri have provided an overview of the various aspects of regionalization, its implementation and resulting impact across Canada. The authors note that although it has had some success in Canada, it remains unclear as to what the single compelling vision or focus is or should be. This commentary suggests that the inability to include all components of the continuum of care within most models accounts for the lack of "transformational change" that regionalization has as yet been unable to achieve. To expect that any significant gains will be made in the regionalization process until all aspects of the continuum are under a region's control is unrealistic. The commentary proposes that it is time to review the underlying premises for regionalization and its current emphasis on acute care.