Health care delivery systems in review.

Physicians are seeking to maintain their practices in the midst of competitive pressures from various delivery systems. However, health maintenance organizations (HMOs) do not have the stronghold they had in the past. Several HMOs discontinued their Medicare risk contracts due to inadequate reimbursement rates, and others experienced financial losses in the October stock market crash. Independent practice associations (IPAs), the most popular HMO type, are particularly plagued by financial problems.