**2.2 Managed care**

Managed care grew rapidly during and after the 1990s, as a way to contain health care costs by changing from fee-for-service payment to prospective payment based upon capitation—the number of individuals enrolled in a health maintenance organization (HMO) plan. That gave insurers yet another way to profit from providing less care, and soon became known as managed *reimbursement* rather than managed care. As insurers found new profits, however, the quality and outcomes of care suffered. By 2000, 65 million Americans were enrolled in HMOs [7].
