Costs of health care are increasing at a rapid rate, but both access to care and costs of care have become focal points for current national and local debates. Access issues relate not only to those who have no insurance but also to those who are underinsured. Cost issues relate most directly to radiology and nuclear medicine through their impact on coverage and payment. Increasing scrutiny is paid to criteria used for these purposes, and major changes at the federal and private level can be expected in the next decade. Finally, the ubiquitous development of practice guidelines and their expected use in physician profiles will influence the practice of medicine significantly in the future.