Question

Health Maintenance Organizations (HMO) came about in the early 1980’s. Define HMOs, what they were intended to achieve, the reaction by Hospitals, patients and physicians as well as the outcome and whether HMOs were considered a success.

Answer 1

Answer :

Definition: Health Maintenance Organization is an organization that provides managed care for health insurance, self-funded health care benefit plans and other entities, acting as a liason with health care providers on a prepaid basis.

They were intended to achieve health services to population for fixed prices.

Response of doctors, patients and hospitals :

Some doctors move away from accepting HMO's, as it pay poorly for health care services from office visits to health checkups /lab tests.

Patients find it difficult as HMO's contract with a certain number of doctors and hospitals in any particular area and insurers won't pay for health care received at out of network providers. But it is a popular choice for budget conscious people.

Hospital visits are only made by patients when they have refferals from their primary care physician. So they will get the prepaid amount if the patient doesn't make a hospital visit.

Outcome of HMO's : It was not able to accomplish its goals completely, as some doctors move away from the organization and operates in particular areas, it's coverage become less.