A. Certainly, managed-care companies are not selecting doctors based on whether they are the best trained but based on who they can control the most.

Costs have been rising faster as the insurers have yielded to customer demands for more freedom to select doctors and hospitals.

H.M.O. managers say that many bills pending in Congress would dilute their ability to hold down costs because the proposals would make it more difficult for them to select cost-conscious doctors.

The report urges employers and other purchasers of health care to select and reward doctors and hospitals that switch to more efficient processes and "best" practices.

There would be strong incentives for people to join health maintenance organizations or other networks that limit their ability to select doctors and hospitals.

Under their proposal, health plans would have to disclose the standards they used to select and exclude doctors from their networks, and doctors would have a right to appeal their exclusion.

Smith and Naifeh write carefully, explaining why they selected certain doctors and treatments and, more important, how and why they rejected others.

Panel Physician: U.S. Embassies and Consulates which issue immigrant visas have selected certain doctors to do the medical examinations for immigrant visa applicants.

Under managed-care plans being debated in Washington, patients would select doctors from lists made by insurance companies or join H.M.O.'s and receive care from groups of doctors for preset fees.

The insurers use the results in selecting doctors whose work is considered cost effective and high in quality.