Across a variety of governments, cost containment has become a primary concern in the health care expenditure. Several strategies are implemented to control rising costs: voluntary hospital planning, wage and price freezes, changes in the amounts and methods of reimbursement for services, development of more cost effective health care delivery systems, and regulatory programs such as utilization review and controls on hospital capital expenditures. However, most of those strategies proved unsuccessful in controlling costs. Another significant health care reform effort is the amendment of the social security act, which established professional standards review organizations. The PSROs were a national network of utilization review programs that had dual responsibility for medical cost containment and quality assurance.