There has been a dramatic upsurge of entrepreneurialism in health care systems in Europe, spurred by interests in better efficiency and quality. The characteristics of entrepreneurial behaviour include seeking opportunity, promoting innovation, and genuine accountability. However, experience so far indicates that entrepreneurial behaviour does not make for an effective health care system in an unregulated “free-for-all”. Supporting regulation is needed to avoid some of the dangers inherent in entrepreneurialism which could sacrifice the core policy objectives of a socially responsible health care system. Bringing a carefully calibrated degree of market-style mechanisms into the health care sector – or entrepreneurialism tempered by regulation – can achieve the best of both worlds: more patient responsiveness and efficiency, combined with publicly accountable providers and values. This does not normally mean more privatization. The key is “a carefully calibrated degree of market-style mechanisms” or, in other words, regulatory strategies that seek to capture the benefits of entrepreneurial innovation without jeopardizing the core policy objectives of a socially responsible health care system.