ABSTRACT
Managed care is usually delivered through health plans of various shapes and structures that, on the surface, appear similar. The truth is that they are very different, although most resemble an entity capable of providing care and the insurance component to protect the enrollee from £nancial exposure for claims arising from incurred covered expenses. This limits the enrollees’ choice and access to those providers within the system, other than primary care physicians (PCPs). The systems often limit their ability to self-refer throughout the system of £xed panels of physicians, facilities, and other contracted providers, a methodology known as a “gatekeeper” approach.
