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Abstract

The last half-century has witnessed a dramatic rise in both health care spending and associated efforts to rein in costs.I As these factors and others coalesced, the "managed care revolution" was born.2 In the last several decades, health maintenance organizations (HMOs) - along with other managed care organizations (MCOs), such as preferred provider organizations (PPOs), point of service (POS) plans, and managed indemnity plans - have attempted to balance patients' quality of care against steadily rising health care costs.3

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