In health care, as in other areas, the early stages of the transition from a Communist system to capitalist liberal democracy have proved bewilderingly complex and difficult to control. Political, economic and social factors weave a complex web of interactions. In Poland, spontaneous, unanticipated reactions both to macro-economic changes and to changes in health care policy characterized the health care system, while administrative decentralization further complicated attempts to steer the process of change and to introduce the systemic reform promised for several decades.