The continuous growth in the demand for water supply and sanitation services has posed decision makers with the challenge to discover new, and to adapt existing, institutions. Since the last two decades, the most prominent institutional change for the water and sanitation sector is neo-liberalism. This book analyses the effects of neo-liberal institutional changes on the strategies and performances of water providers. In this regard, studies are executed in the Netherlands, the Netherlands Antilles, the United Kingdom and Italy on what water providers can do, want to do and actually do. It is concluded that neo-liberal institutional changes matter for the strategies of water providers, but that no conclusion can be reached with respect to performance effects.