Hill Burton Act
(1)    Provided federal funds for communities to develop hospitals.  10% of the cost was to be spent on indigent patients.
(2)    There was an explosion of hospitals and today there are 700 hospitals in the U.S. with 1/3 of them bordering on bankruptcy.
(3)    This led to an increased cost between the hospital and the physician.  Insurance provided for payment only of the usual and customary fees.
(4)    In turn, that led to the development of managed care where the payor has administrative oversight.  Two examples are:
(a)    HMA:  Contract with the patient and the doctor where the doctor justifies the need of procedures to the HMO.
(b)    PPO