Managed care as typically practised in health maintenance organizations (HMOs) (as opposed to case management, see below) poses a number of dangers to the health care of individuals with disabilities and/or chronic illnesses. Similar managed-care cost-control techniques in traditional health insurance programmes pose the same risks. Essentially, the problems fall into two categories: (1) those related to economic incentives that lead to under-service, and (2) those related to the nature of this group's health-care needs. Modification of managed-care programmes may remove such dangers, but these modifications are unlikely unless policy-makers change their assumptions about and expectations for managed care.
In one American state, 14 HMOs cover 45% of the population of patients, and so doctors now largely depend upon HMOs to obtain patients.