Through a case content analysis of over 450 court cases, this study examines whether the courts have systematically favored cost containment over access to health-care services across different types of court cases. We found that across all cases, the courts were more likely to rule for managed care defendants than individual plaintiffs. We also found that courts are actively considering policy objectives in their decisions and these policy issues are correlated with case outcomes. In particular, the courts were significantly more likely to rule for the plaintiff when justice/fairness issues controlled in the case outcome, but far more likely to rule for the defendant when cost/economic efficiency issues controlled. Our results suggest that while courts appear to be considering policy trade-offs, they have refrained from an active policymaking role by refusing to second-guess public policy favoring cost containment.