Managed care strategies have been introduced into the South African private health sector a decade ago to help reduce medical costs in this sector. A cross-sectional survey using a self-administered questionnaire was conducted among primary care physicians in this sector to access their perceptions of these strategies and to analyse impact of these on their clinical behaviour. The results indicate that although insurers were not using these strategies extensively, doctors generally perceived them negatively. It was, however, pleasing to note that the newer generation of doctors, appear to be more accepting of this new philosophy of health-care delivery. © 2008 Royal Society of Medicine Press.