AbstractThe scarcity of resources in healthcare systems has general causes and country‐specific causes. Common to most healthcare systems is a strong emphasis on management and an increased attention to the role of the market. Management and market are concepts which need clarification: management applies not only to individual institutions but to systems of institutions. Market implies not only the pursuit of individual interests but also the assumption of responsibility. The design or redesign of healthcare systems must take into account the level of management skills which each system and its institutions can rely onCost patterns in a healthcare system develop around its institutional design. Different factors produce varying levels of costs in different healthcare systems. The same applies to the effort needed to reach a certain degree of effectiveness in output. An outline of strengths and weaknesses of options for the design of healthcare systems is presented in the final part of the article. These should always be considered together with the specific features of each countr