This book focuses on how a distinctly American product--managed care--got its start, how it works, and what needs to be adjusted in the future. The unprecedented integration of services in health maintenance organizations (HMOs) is better for the consumer, yet, at the same time, results in less control by the consumer and provider. Making the relationship between consumers and providers less trustworthy is the shadowy figure of the third-party payer, who, by exercising control, is attempting to keep costs down. This book is about social change. It is about doctors contracting with HMOs and being subject to their rules; about the limited access to specialty care; and about the frugal use of hospital admissions and stays. Consumers and providers have had mixed experiences with HMOs. Birenbaum, a health-policy analyst, has created a synthesis of research studies and analyses of trends to chronicle these developments and to suggest remedies to correct the most unjust aspects of managed care. This is important reading for anyone concerned with contemporary health care in America.