Introduction: Managed care is a structural approach within the United States health system aimed at controlling increasing healthcare costs and enhancing service delivery efficiency. This study examines the organizational framework, economic and quality outcomes of managed care in the U.S., while exploring its potential applicability within the Iranian health system.

Methods: This analytical review was conducted by searching reputable scientific databases, including PubMed, Scopus, SID, and IranMedex. The MeSH keywords used were: “Managed Care Programs,” “Health Care Costs,” “Quality of Health Care,” “Health Insurance,” “HMOs,” “PPOs,” and “Cost Control.” Articles published between 2000 and 2023 were selected and analyzed.

Results: The three primary models- Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Service (POS) plans- have demonstrated cost-reduction capabilities through mechanisms such as access control, negotiated pricing, and structured provider networks. While these models have achieved relative success in decrease expenditures, they continue to face challenges in maintaining service quality and ensuring satisfaction among patients and providers. Common criticisms include limited provider choice, the gatekeeper role, and delays in accessing specialized care.

Conclusion: Although managed care models have proven effective in cost containment, they often struggle to balance quality, accessibility, and stakeholder satisfaction. The Iranian health system may benefit from adapting elements of the U.S. managed care experience, provided that any localized model incorporates robust oversight, safeguards patient autonomy, and emphasizes preventive care and primary health care services.