This book explores the changing relationship between payers and providers, and how these changing relationships affect patients; how the tensions between payers and providers are managed in the 1990s will be an increasingly important determinant of who gets what care, how good it is and how much it costs. A dominating theme facing all health care delivery systems concerns the move from a provider dominated set of institutions and processes, towards something different. The fundamental issues of health, disease and disability, and of medical care are the same in any country. The papers included in this book reflect on the situation in different countries of the world.