In modem societies, people are strongly urged to get the best health care for themselves and their families. Although controlled costs of the health care system may be an important goal for society as a whole, the individual patient is seldom satisfied with being an object of health care rationing. When, due to financial constraints, the health services covered by the public programs become rationed and their quality is perceived as decreasing, patients tend to contract with the providers directly. From the societal viewpoint, supplemental payments for improved care play a negative role when they lead to competition for limited resources in public programs and therefore decrease access for the non-paying patient. They, however, play a positive role when they create new resources and when they thus do not affect the access for the poor negatively, or even improve it by increasing overall health services supply.