Over the past few decades, managed care has grown to become the dominant organizing and financing mechanism for U.S. health care, changing dramatically the way in which health care services are delivered. Individuals with cancer are less likely to be covered by managed care plans because they are elderly and tend to have Medicare's traditional fee-for-service coverage. Nevertheless, many aspects of cancer care—for example, access to specialists, coverage for drugs and ancillary services, and use of practice guidelines—differ in managed care compared to fee-for-service care. In response to market forces, managed care organizations have consolidated, diversified, and become quite heterogeneous, making it difficult to generalize about their impact on cancer care. States, in some instances, have tried to counter the effects of managed care by mandating certain benefits or consumer protections. These mandates, however, do not apply to many Americans whose health plans are self-funded by an employer and therefore exempt from state regulation.

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