in the health care sector reforms have aimed at introducing more competition despite major changes and some positive effects the reforms run the risk of getting stuck in the middle between a centralised system of statecontrolled supply and prices and a decentralised system based on regulated competition providing insufficient incentives for provision of quality services and expenditure control the main challenges are to complete the transition to regulated competition in health care provision to strengthen the role of health insurers as purchasing agents and to secure cost containment in an increasingly demanddriven health care sector