How has HMO influenced the current health care system?

http://en.wikipedia.org/wiki/HMO

This article has a good explanation of what the whole HMO concept is and how it has affected the entire health care system in the US.

Sometimes HMOs are good; they can save people money and/or make health insurance affordable.

Sometimes HMOs aren't so good; the dilly-dallying while getting approval of the primary care doctor's referral to specialists and other "bean-counter" types of actions can result in a patient's becoming sicker while waiting for the referrals to come through.

Everything comes with choices and options ... and decisions need to be made. If those decisions aren't made in a timely fashion, people's health deteriorate. On the other hand, for normally healthy people, HMOs can be a cost-saving way to go.

Sometimes HMOs make it very difficult on patients. Several years ago when my granddaughter was 12, she missed the vault at a gymnastics meet. It was obvious to the many observers that she could have broken her neck or back. Of course an ambulance was called and she was transported to the hospital. Fortunately she was not injured and returned to the meet within a couple of hours.

Their HMO questioned the hospital visit and my daughter spent a lot of time and energy convincing the HMO that the hospital was an absolute necessity.

WATCH THE MOVIE BY MICHEAL MOORE! ITS GOOD but then again biased- but you can take your own views out of it!

What does this have to do with health care?

To understand how Health Maintenance Organizations (HMOs) have influenced the current health care system, we first need to know the basic concept and working principles of HMOs.

HMOs are a type of managed care organization that provides health care services to individuals for a fixed, prepaid fee. They offer a comprehensive range of medical services, including preventive care, treatment, and hospitalization. HMOs typically operate by assembling a network of doctors, hospitals, and other healthcare providers who agree to provide services to their members at predetermined rates.

Now, let's discuss how HMOs have influenced the current health care system:

1. Emphasis on Preventive Care: HMOs have been instrumental in promoting preventive care. By providing routine check-ups, screenings, and vaccinations, they focus on early detection and intervention, which can potentially reduce the need for expensive treatments later on. This emphasis on preventive care has become an integral part of the current health care system, with many insurers and providers incorporating it into their coverage.

2. Cost Control: HMOs were designed with the goal of managing health care costs. They accomplish this by negotiating discounted rates with healthcare providers within their network, emphasizing cost-effective treatments, and implementing utilization management techniques. As a result, HMOs have influenced the broader health care system by introducing cost control measures that have been adopted by other insurers as well.

3. Managed Care Principles: HMOs operate on managed care principles, which involve coordinating and managing the overall health care of their members. This includes coordinating referrals to specialists, ensuring appropriate utilization of services, and promoting a continuous relationship between patients and primary care physicians. Many aspects of managed care have been integrated into the current health care system, particularly in the form of provider networks and care coordination initiatives.

4. Health Insurance Reform: The rise of HMOs has influenced health insurance reforms in various ways. HMO-style contracts and payment structures have been incorporated into different insurance plans, such as preferred provider organizations (PPOs) and exclusive provider organizations (EPOs). Additionally, the concept of healthcare networks, where providers agree to deliver care at predetermined rates, has become a common feature in insurance plans.

Overall, HMOs have significantly impacted the current health care system by promoting preventive care, introducing cost control measures, popularizing managed care principles, and influencing health insurance reforms. Their emphasis on coordination and cost-effectiveness has shaped the way health care is delivered and financed today.