From the eighties many developed countries withdrew from many sectors of the economy in order to sustain international competitiveness and financial sustainability while preserving a dominant role on the market of health care. Such trend can be explained by ageing populations, the diffusion of health care technologies, changes in the disease structure and in the preferences of the society. In this study the authors examine these phenomena through the review of the British and Dutch health care systems and allocation mechanisms. Both countries design their health care system through very similar principles: efficiency and equity; and also follow quite different socio-economic preferences, while they respond to challenges in different ways. The role of private sector in the Dutch health care system has been increasing and this has resulted in the development of a national health insurance system based on regulated competition. The underlying principal of British health care has been the promotion of equity which has strongly endorsed the preservation of state-held territorial service monopolies. In spite of finding rudimentary differences in the two countries' health system, governments' role in redistributing health care resources and coordinating health care market remained dominant. At the same time, with the pressure on national health care budgets the role of the private sector, efficiency considerations and competition amplified. The authors find that in spite of the challenges of the global and domestic environment, national health policies still have the possibility to take public preferences firmly into account, and, as a consequence, welfare states do not only reflect to recent changes in the health care sector but have the potential to bring them about.