In our report, we pose a number of questions concerning this new organizational framework for care systems, based on greater rationalization of the health sector, and the use of procedures and methods which vary from country to country.

We will examine the options chosen by social security institutions. As administrators of the risk, they have a central role to play in the implementation of new organizational frameworks and their control, in the search for optimal management of the health sector. This policy is in line with the trend to give more responsibility to the actors involved in social security and with the modernization of the institutions.

We will illustrate our text with examples from several countries (France, Great Britain, United States, Switzerland and Chile). Based on this information, we will attempt to highlight the positive aspects, the difficulties and the problems encountered in the implementation of managed care.