About 60 to 70% of hospital services are non-urgent, elective procedures. At least in those indications, insurance companys can deliberately choose their partners among the providers. This forces hospital owners and other providers to enhance their performance, to sharpen their profile and to improve their image in the emerging market. Image in the market of health care is only acceptable as a race for improved quality and evidence-based clinical pathways with defined steps with full disclosure of the agreed indications. The next step will lead to management coorporations as a link between partners, who will take over responsibility for reimbursement, reinsurance and all management tasks. Integrated Health Care is a promising first step.