The health care concept "managed care" became popular in the United States during Ronald Reagan's presidency as a method to control Medicare payments. The most popular form of managed care is the use of Health Maintenance Organizations or HMOs. For a fee, an HMO allows subscribing members to access the services of a network of doctors and participating facilities.

HMOs are essentially insurance plans and they have come in for heavy criticism as the insurance company basically controls all aspects of the insured individual's health care through a "gatekeeper" known as a primary care physician.

While the concept is to provide lower cost health care the end result has been the growth of a bureaucracy that can greatly slow down health care and at times even deny procedures and services to the insured. A further complication is that since the 1980s HMOs have been protected by federal law from malpractice proceedings.

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