A

Clinton’s efforts to restructure the health care delivery system in the United States in the early 1990s were unsuccessful legislatively, that system in fact was undergoing massive change in the private sector. Opponents of the president’s controversial plan said that we could trust the American marketplace, the hallmark of which is the concept of fair competition and its concurrent improvements in quality and consumer satisfaction, to reduce the ever-increasing costs of health care in this country. What the market delivered was a rapid expan-sion of health care delivered through managed care organizations or networks of providers, paid on a prospective, often per capita, fixed basis. This changed the dynamics of reimbursement in health care from a retrospective, fee-for-service basis to a prospective, capitated one. With such controls on the input side of the equation, the risk of undertreatment and denial of care took center stage on the output side, where once had been concerns for overtreatment and the attendant costs and risks of unnecessary care