Regarding the organization and delivery of care, the 1992 reform was aimed toward a quasi-market for health care services, with LHUs and regions able to contract with competing public and private accredited providers. This new model of competition has emerged to varying degrees across regions, and has gradually changed. In some regions, the model has been fully implemented (e.g., Lombardia in the late 1990s), while in others the actual allocation of resources to hospitals has never followed competitive mechanisms (as in southern Italy). In addition, market mechanisms have increasingly evolved to balance financial incentives for quality and efficiency with clear safeguards for the financial viability of the system. Regions have used the hospital accreditation system and introduced caps on spending to create barriers to entry and to maintain control over expenditure.