The literature review reveals that a trend toward carve-out and for-profit MC organizations is associated with lower financial incentives for intensive treatment than in earlier staff-model and not-for-profit MC organizations. The value of drug abuse insurance coverage has declined by 75 percent between 1988 and 1998 for employees of mid-size to large-size companies, compared with only an 11.5 percent decline for general health insurance. The shift towards MC has also been associated with a drastic reduction in the frequency and duration of inpatient hospitalization; no clear indication exists that a corresponding increase in outpatient support has offset this reduction. In addition, a survey of physicians conducted by the American Society of Addiction Medicine revealed that the majority believed that MC had a negative impact on detoxification and rehabilitation, as well as on their ethical practice of addiction medicine. The analysis concludes that MC has contained costs, but unintended consequences are the decreased value of drug treatment benefits, reduced availability of appropriate care, and reduced autonomy of clinicians to make treatment decisions for the individuals they treat. 58 references (Author abstract modified)