From a societal perspective why is it thought that managed care orgaizations(HMO's) provide lower quality care than Fee-for-service plans?
The answer is in the answer to this question: If you were facing a life threatening disease, would you bid it out and choose the low bidder to treat you?
Yes, I am aware that some will add the word "qualified" to the term low bidder here, however, my experience in qualified low bidder is not good, there is a bid difference in paper qualifications and real world performance.
If you wanted to get your daughter married, would you give her away to the highest (qualified) bidder? I wonder what she would have to say on it.
HMOs have received some bad publicity because of some bonehead decisions.
For instance, many years ago my granddaughter had an accident during a gymnastics meet. All of the many people who saw it, knew that she could well have a broken back or neck. She was taken by ambulance to the hospital -- where (thank goodness) it turned out she was fine. However the family HMO hassled the family for several months about paying for the ambulance and examination. Eventually it gave in -- but it certainly left me with a negative impression of HMOs.
what if there is an evened out financial problem, meaning like at the current low levels of employment and you do have almost no other appealing options, what would you do? I guess the poor man dies if he /she gets a massive heart stroke or any other emergency! Right?
From a societal perspective, it is commonly believed that managed care organizations (HMOs) may provide lower quality care than fee-for-service plans due to several factors. However, it's important to note that this is a generalization and not true for all cases. Let's explore the reasons behind this perception:
1. Cost Savings: HMOs typically emphasize cost containment as a primary goal. To achieve this, they often limit the choice of healthcare providers and require patients to receive care within a specific network. This can sometimes lead to restricted access to specialists or hospitals, potentially resulting in delays in care or limited treatment options.
2. Incentives: Fee-for-service plans reimburse healthcare providers based on the number of services they provide, creating financial incentives for providers to deliver more treatments or procedures. While this can lead to overutilization and unnecessary procedures, it also encourages thoroughness in diagnosing and treating patients. HMOs, on the other hand, often provide fixed payments to providers, which may create incentives to limit services and reduce costs. This could potentially lead to underutilization of necessary treatments or interventions.
3. Focus on Preventive Care: HMOs tend to emphasize preventive care measures and wellness programs to keep patients healthier and reduce long-term healthcare costs. While this is beneficial from a cost standpoint, critics argue that HMOs may spend fewer resources on complex or expensive treatments, potentially compromising the depth or quality of care provided.
It's crucial to understand that assessing the quality of care requires a comprehensive evaluation, including patient outcomes, patient satisfaction, provider qualifications, and access to appropriate care. While managed care organizations like HMOs often face skepticism regarding quality, many have implemented measures to improve care while still managing costs effectively.
To gain a more accurate understanding of the quality of care provided by HMOs compared to fee-for-service plans, it is vital to analyze empirical evidence, such as studies, patient reviews, and ratings from reliable sources.