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With mounting political and economic pressures upon health care infrastructure, many developed countries have taken steps to control health care expenditures. This has taken place against a backdrop of increased demand associated with changing demographic structures, technological advance and increasing consumer expectations. Beginning with an analysis of the US, where markets have been an inveterate feature of health care provision, the authors seek to compare and contrast the US experience with developments in Sweden and Britain. The analysis takes place within a general framework which gives recognition to issues such as efficiency and effectiveness, cost control, equity and consumer choice.

The development of skiing safety work in Sweden is described starting from the 1930s. After the first conference on ski trauma and skiing safety, which took place in Riksgränsen, Sweden, in 1974, an international skiing safety organization was formed. A strong safety campaign was launched in newspapers, on television, and in other media. Different organizations joined the campaign and bad release bindings were banned. Bindings were tested at ski slopes all over Sweden. A cost-benefit analysis was carried out in 1983 to evaluate the economic outcome of the campaign. It showed that thanks to the campaign, apart from the humanitarian gains, the annual average sum saved by the community amounted to almost four million crowns, or a yield of five on each crown invested in the campaign. From the economic point of view, the campaign thus was quite worthwhile.