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HMO: Overview From Health Physician, Essay Example

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Health maintenance organization is an organization which aims at managed care model in arranging health insurance, funded and self funded benefit options and other insurance schemes for people who live in United States. It acts as mediating agency between health care providers like hospitals, health professionals and physicians with the insurance providers (Peter, 2001). As per the health maintenance Organization Act introduced in 1973, it is a prepaid system which needed huge number of employers with a small group of about 25 employees who would be able to give HMO certified opinions on health care. In addition HMO works through contracting employees who agree to treat patients according to the stated guidelines attract new customers and maintain flow of existing customers. The added advantage is the emergency care offer through the health physician whatever the status of contract is. The major principle on which HMO works is through management of care where major catastrophic disorders like diabetes, cancer, asthma are classified and identified in terms of defined patient care (Joseph, 1975). The treatment evaluation strategies are prepared corresponding to recommendations and great involvement is proposed by assigning a manger for set of grouped patients suffering from similar disorders. This way, it benefits the involving physician on same number of case studies involving less effort, time of investigation and resources along with mutual benefit of enhanced care on the patients (Health Affairs Study Finds, 2000). HMO works on cost containment through case management however do not profit on large scale. The cost containment is achieved by reducing health care diversifications. The overall cost cut down is benefitted through maximum utilization of health resources which ultimately cheer up consumers through cost saving (Jaeun and Sangho, 2007).

References:

 “Claim That HMO’s Save Money Is Little More Than “Folklore,” Health Affairs Study Finds,” 2000. Physicians for a National Health Program.

Joseph L. Dorsey, “The Health Maintenance Organization Act of 1973(P.L. 93-222)and Prepaid Group Practice Plan,” Medical Care, Vol. 13, No. 1, (Jan., 1975), pp. 1–9

Jaeun Shin, Sangho Moon, “Do HMO Plans Reduce Expenditure in the Private Sector?”, Economic Inquiry, Jan 2007.

Peter R. Kongstvedt, “The Managed Health Care Handbook,” Fourth Edition, Aspen Publishers, Inc., 2001, page 40.

 

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