<prompt> Translate the following text to EnglishMarekebisho katika huduma kusimamiwa zinahitaji kufanywa - na chini ya shinikizo kutoka kwa watumiaji na wawakilishi wao katika Bunge, tayari zinafanywa.  <response>: Adjustments in managed care need to be made--and under pressure from consumers and their representatives in Congress, they are already being made. 