`titrebCollective Enterprises in the Health Sector: An Institutional and Organizational Innovation`/titrebIn the debates surrounding the management of healthcare systems, there is a tendency to limit analysis to models of public and private for-profit organizations, thus neglecting the growing importance of so-called “collective” enterprises, such as cooperatives, not-for-profit organizations, and, in developing countries, mutual companies. Defined by their end use, democratically run and based on free and voluntary membership, these organizations, which are collectively owned by their user-members, represent significant potential for institutional and organizational innovation. Since the user-members have the final word in determining the development of the collective enterprise, a strong capacity to adapt to changing needs is observed. The authors explore this new reality, in which the users themselves are in control, based on a presentation of two models of collective organizations in Quebec. The article also looks at some of the criticisms that have been levelled at this type of structure within the health and social services sector. In conclusion, the authors argue for greater complementarity between the public economy and the social and cooperative economy within the health sector.