The global restructuring of health care employs and invokes consumerism and consumerist models. In Britain, Sweden, the United States and Canada, consumer ‘overutilization’ is a frequently cited source of escalating costs, while more informed consumer control and awareness are posited as solutions. As concern about increasing costs grows, and proposals for the reduction of health care spending advocate ‘more rigorous control of the supply-and-demand forces that drive health care services’, (Bagley, 1994:1747-1748) the shadow or spectre of ‘consumer abuse’ looms ominously over discussions of demand.