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In the united states the organisation of care is strongly marked by “Managed care”, a generic term which covers any system integrating at one and the same time both care financing and the services provided. In 2000, more than 70 % of Americans subscribed to some managed care plan either via their employer or individually – or again within the framework of the “Medicare” and “Medicaid” public insurance programmes for the elderly, the handicapped and certain poorer families with children. The strong qrowth of “managed care” in recent years has profoundly affected relationships between the various players in the health system, with the introduction of incentive regulatory instruments on both the supply and demand sides. Any assessment of these new regulation methods and their influence on the American health system remains sensitive. What role has been played in the slower gowth in health expenditure in the United States, by the rationalization policy in the production of medical goods and services carried through by the “managed care” organisations. Have these latter not gone too far in their policy of controlling access to care? what in particular has been the effect of the generalization of “managed care” on the quality of this same care? These are the questions this article tries to answer.