Talk:Health maintenance organization
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[edit] NHS as HMO?
From the side of the Atlantic mainly associated with HMOs, would you regard the British NHSs as HMOs? Midgley 22:49, 13 May 2006 (UTC)
- I would not. Although both attempt to control costs in a similar manner, HMOs are designed to compete in market-based health care systems. As you know, the NHS is part of a publicly-funded health care system. -AED 00:52, 14 May 2006 (UTC)
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[edit] Regulation of HMOs (missing section?)
eg in California, the department of managed health care. http://www.dmhc.ca.gov/library/reports/ I'm not in a position to write it. Midgley 15:24, 20 May 2006 (UTC)
[edit] Article
This article has been gutted of numerous sections since August - I don't understand it. I'm doing a LONG revert because the article was much higher quality at that time, if anyone wants to sort out the *POSITIVE* changes made since then, go ahead. 160.253.0.7 22:17, 7 February 2007 (UTC)
[edit] HMOs were not historically insurance companies
Insurance companies have great incentives to deny care to their insured. They also have great incentives to deny payment to healthcare providers.
HMOs sought to manage care rather than manage the costs of treating sickness. HMOs sought to prevent sickness and thereby prevent the need for costly healthcare.
Further HMOs were not-for-profit and thus were commited to serving the community, often serving the poor via welfare programs at costs equal to or lower than corporate workers in group plans. As a result, HMOs often ended up with the most expensive to care for patients, patients with cronic conditions requiring active management.
To some degree, the lower cost of administration and no need for profits allowed them to compete with insurance companies. Further, they set standards of care that required insurance companies to match them, principly minimal paperwork and no complex patient billing requiring negotiation with insurance companies. FUCK YOU. The HMOs not only incurred the cost of service, they paid it, so they streamlined the process. On the otherhand, you were required to use the HMO staff and facilities which helped control costs. As a result, insurance companies responded with PPO plans and other similar structures. This allowed the insurance companies to compete for the most profitable patients, those in corporate group plans. HMOs needed to maintain their client base so they became PPOs which required they develop billing practices that conformed to insurance company requirements. This was followed by carving the insurance aspect out of heath management, which then put pressure on the time and resources available for health management, as insurance companies tend to cover the least amount of care possible. Thus the golden age of HMOs came to an end, along with most HMOs.
This is my view of HMOs formed over several decades, reading about them, being served by one, talking with people working at HMOs and in other healthcare providers, experiencing and reading the news of the transformation of MTHP from HMO to two separate entities: insurance plus provider, then experiencing the split of the two, the sale of the insurance from the not-for-profit the the for-profit Anthem, now owned by Wellpoint. If I had good original source material to reference, I would update the article. Lacking that, I provide my own original material as talk in the hopes someone will be spurred to improve the article with details from the debates and trials and tribulations of the rise of HMOs and their demise. Mulp 07:49, 17 February 2007 (UTC)
