If Laredo pediatric allergist Gladys Keene, MD, and her husband, otolaryngologist Roger Keene, MD, had their druthers, they would maintain the solo practices they have had for the past 20 years. But they know changes in the form of managed care are coming to the border city, and medicine as they know it will never be the same again. Preferred provider organizations have already captured about 20% of the Laredo market in the past 2 to 3 years, and health maintenance organizations (HMOs) and capitation are not far behind.
如果拉雷多的儿科过敏症专科医生格拉迪斯·基恩（医学博士）和她的丈夫、耳鼻喉科医生罗杰·基恩（医学博士）能随心所欲的话，他们会继续维持过去20年一直经营的单人诊所。但他们知道，管理式医疗形式的变革即将降临这座边境城市，他们所熟知的医疗行业将一去不复返。在过去两到三年里，首选供应商组织已经占据了拉雷多约20%的市场，健康维护组织（HMO）和按人头付费模式也紧随其后。
