Health care delivery systems in review

As physicians grapple with restrictive utilization review procedures, evidence indicates that these measures are not as cost effective as originally believed. Cost containment pressures from employers, limitations on price fixing and incentive arrangements all contribute to a further controlled environment for physicians practicing within HMOs. An SMG census reveals that HMO enrollment grew significantly in 1988, while the number of plans declined. The financial condition of the industry is improving, despite the demise of one of the largest plans. Successful plans are analyzing their market share and developing niche products to improve their position.