12. Clearly, there has been a crying need to restructure health care delivery organizations and their management. Managed care was promoted as a mechanism for that purpose since it requires restructuring f inancing (capitation) and a focus on primary care. This would assure care for a population (of members) living in proximity to the care sites·and§having first stop access to a primary care provider responsible for all other care required by members through referrals and follow up by specialists. This structure was expected to cut down waste from misuse of medical resources and improve quality and efficiency, while controlling costs. In local areas, locally organized services rather than branches of mega national organizations would be better able to meet those care needs as they are familiar with the community and other local resources.