Under various ideas for change, many or most Americans are likely to join managed-care networks like health maintenance organizations.

After receiving a list of doctors in the company's managed-care network, he saw a psychologist whose fee was $10.

The kinds of managed-care networks he has been involved with do not allow the personal interaction that attracted him to medicine in the first place.

Switching to a managed-care network is wrenching for any patient, since it often requires a change of doctors.

Laws in 15 states make it difficult for managed-care networks to exclude any pharmacy.

Health care costs for participants in managed-care networks fell for the first time last year, down 3.8 percent from 1994.

And many force employees to pay more of the costs to see doctors outside the managed-care network.

Without the rate increases, the company said, it might be forced to drop the policies altogether and offer the customers only coverage through managed-care networks.

As a cost-cutting measure, Empire hopes to move a majority of its 7.6 million customers into managed-care networks in the coming years.

The cost of care provided by managed-care networks fell for the first time.