This chapter focuses on cost containment and efficiency enhancing strategies that alter the public-private mix in health care financing and delivery in leading jurisdictions. These strategies redistribute the benefits and costs of health care, often through processes of privatization. I argue, in a comparative perspective, that cost containment necessarily involves privatization in some dimension of the health care system, with much of it occurring ‘passively’ or ‘by stealth’. Privatization is largely a by-product of cost containment strategies applied stringently, but may also result as a by-product of strategies that enhance the efficiency of health care delivery.1 My contention is that if privatization is to occur it should be the result of an explicit, inclusive and informed public debate that generates a set of priorities for the financing and delivery of health care, and that includes an understanding of the full consequences of health care reform. The public debate in industrialized countries has largely treated privatization in the dichotomous terms of markets versus regulation with the more extreme versions of these stories dominating the debate. Privatization in health care is a much more complex and subtle process. So far policy-makers have ignored this fact.