Since March of 1999, health care providers in Ontario have been competing with each other for a share of the health care market by responding to Requests For Proposals put forth by a single local government agency called a Community Care Access Centre. This thesis borrows a fairness framework form the field of organizational justice and uses the related concepts of procedural and distributive justice to explore the factors involved in the creation of a level playing field in the managed competition environment. Findings suggest perceptions of fairness are influenced by factors such as an agencys size, union status, for-profit/non-profit status, success to date, the external environment and the passage of time. Participants were more likely to perceive the RFP process as fair if certain attributes were attained including establishing clear expectations, basing the judgment on criteria and obtaining consistency within and among CCACs.