The existing health-care delivery system in the United States is a conglomerate of health practitioners, agencies, and organizations, all of which share the mission of health-care delivery but operate more or less independently. The greatest portion of all patient services is provided in offices and clinics by physicians who sell their services on a fee-for-service basis. The majority of Americans have health insurance benefits through their place of employment, paid for by contributions from both the employee and the employer, but because of the high costs of health care, there has been a shift from unmanaged plans to managed where utilization is closely monitored. The number of citizens without health insurance continues to increase, and the American health-care system has been called the best in the world, but also the most costly, inefficient, wasteful, and inequitable system of health care in the industrialized world. © 2008 Copyright © 2008 Elsevier Inc. All rights reserved.