The concept of managed care evolved in the USA as a way of containing costs and promoting quality in health care. Some vital lessons can be learned from this experience and many of its benefits can be applied to the UK as the NHS internal market develops. However there are also pitfalls which it is equally important to avoid. This is the first book to provide an in-depth analysis of the contracting techniques seen in managed care. The author is in the rare position of being an NHS manager with practical experience of the US health care system and has produced a first hand contemporary guide to managed care highlighting its strengths and weaknesses and its relevance to the UK. To set the current debate about the future of the internal market and GP fundholding in context the author offers a critical review of the NHS reforms and current management and clinician competencies. Citing American experience of the role of doctors in management he demonstrates both the power and limitations of such initiatives.