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.
Health organizations treat the insurance contract and not the patient. Doctors are being forced to react to the needs of managers, not those of patients.
More American doctors previously practised privately and many held patients' health to ransom with unfairly high fees. Doctors deserve to be at the mercy of cost-cutting management, for they failed to set their prices fairly when it was in their power to do so.