Acknowledgments List of Interviews Conducted in Cuba List of Abbreviations Preface 1. Introduction and Background 2. Social Capital and State Capacity 3. Political Will and Cooperative Institutional Arrangements 4. The Limits of State Capacity and Social Capital in a Top-Down System: Exclusion and Non-Participation 5. Underground Health Care Arrangements as Temporary Solutions and Long Term Challenges to the Formal System 6. Conclusion References Index