ABSTRACT
During the 1980s, competitive forces to contain costs replaced the direct regulatory efforts attempted in the United States during the 1970s. Health maintenance organizations (HMOs), which have a long history of serving a relatively small segment of the population, and other payment systems such as preferred provider organizations and managed care networks figure strongly in the increasingly competitive US health care environment. HMOs are specifically defined for the purposes of federal and state regulatory agencies, but a generic definition includes the contractual responsibility to assure the delivery of a range of medical services to an enrolled population, which is periodically offered a choice of plan. One key difference between the United States and many other developed nations is the role of government in the medical care system. A key aspect of the HMO concept is that providers control the whole range of benefits.
