The American hospital is often half-empty, and many of its patients should be at home or in extended-care facilities. The US health care delivery system has been described as a "cottage industry," that is, its providers tend to resist organizing themselves into larger organizational units. Single-visit primary care is usually for an acute condition, but consumers often lack a defined provider of usual-place primary care, and must therefore turn to strangers for nonacute conditions. Foundations for medical care, based on the format established by the Medical Foundation of San Joaquin, California, join physicians with individual practices into an organization that reviews utilization, monitors insurance claims, and sets criteria for benefits and fees. Associations perform the same activities, but are more likely to be prepaid group practices. Prepaid group practice plans have been fought by organized medicine, but they have managed to survive and have produced some of the most significant, yet controversial, results in the delivery of health care.