<P> By the late 1990s, U.S. per capita healthcare spending began to increase again, peaking around 2002 . Despite managed care's mandate to control costs, U.S. healthcare expenditures has continued to outstrip the overall national income, rising about 2.4 percentage points faster than the annual GDP since 1970 . </P> <P> Nevertheless, according to the trade association America's Health Insurance Plans, 90 percent of insured Americans are now enrolled in plans with some form of managed care . The National Directory of Managed Care Organizations, Sixth Edition profiles more than 5,000 plans, including new consumer - driven health plans and health savings accounts . In addition, 26 states have contracts with MCOs to deliver long - term care for the elderly and individuals with disabilities . The states pay a monthly capitated rate per member to the MCOs that provide comprehensive care and accept the risk of managing total costs . </P> <P> One of the most characteristic forms of managed care is the use of a panel or network of healthcare providers to provide care to enrollees . Such integrated delivery systems typically include one or more of the following: </P> <Ul> <Li> A set of designated doctors and healthcare facilities, known as a provider network, which furnish an array of health care services to enrollees </Li> <Li> Explicit standards for selecting providers </Li> <Li> Formal utilization review and quality improvement programs </Li> <Li> An emphasis on preventive care </Li> <Li> Financial incentives to encourage enrollees to use care efficiently </Li> </Ul>

The main focus of a health maintenance organization (hmo) is to provide