Under current circumstances, these issues may be moot if the number of existing general "pediatricians" and payment differentials between them and other family practitioners are nominal. However, if future events (such as a tightening by the American Academy of Pediatrics or the American Board of Pediatrics as to what constitutes the definition of "pediatrician") should skew this distribution, then affected health entities could end up either facing a higher payment differential in meeting the requirement of these bills or eliminating their internal requirement that their enrollees designate a primary care provider. This, of course, could lead to increased "doctor shopping" and discontinuities in care. Managed care had been originally seen to combat both of these events, which had historically been considered to drive up health care costs.