Within some managed care systems, physicians who perform more procedures and spend more time with patients than is deemed necessary are penalized or physicians are simply paid based upon their number of patients, rather than the extent of the care they give to patients (Jecker 1998).

Managed care was designed to reduce the tendency of physicians to please patients with 'good' health insurance by allowing them to take drugs (such as brand-name medications or antibiotics) when they were not strictly necessary or have tests for which there was little indication that they would be beneficial for the patient. One of the most controversial aspects of managed care was the insistence that patients obtain referrals for specialists and the need to remain 'in network' for treatments. This was despite the fact that medical opinion might vary widely in terms of the best way to treat an illness. A patient with cancer...
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