During the past decade, health care system reform has emerged as a primary concern in industrialized democracies. Australia, Spain, Italy, and Germany introduced major systemic reforms during the 1980s and are now contemplating further change (Scheffler, Rossiter, and Rosa 1990; Hurst 1991; Commonwealth of Australia 1991; Deeble 1991; McClelland 1991; Organization for Economic Cooperation and Development 1992). The United Kingdom, the Netherlands, New Zealand, and Israel have recently proposed or launched health care system reforms (Netherlands Ministry of Health, Welfare and Cultural Affairs 1988; Her Majesty’s Stationery Office 1989; State of Israel 1990; Chernichovsky 1991; Day and Klein 1991; Upton 1991). Sweden has also been experimenting with a variety of systemic changes (Twaddle and Hessler 1986; Saltman 1990), and major systemic reform was recently proposed in the United States (White House Domestic Policy Council 1993), but did not succeed in becoming law.