Question

HMO’s improve health care. HMO’s do not improve health care. The debate goes on.

             Discuss the tools and features HMO’s use to improve health care—give examples--  

             Take a position on this issue and explain your view.

Answer 1

There are many managed care services providing health care services to improve the quality of health care. Among these, Health Maintainance Organization (HMO) provide a wide variety of services through the providers. HMO promotes more preventive services than any other services. In HMOs, the individual has the authority to choose the primary care physician and he gives a referral to see the specialist. For ex: If the patient with the knee injury, first the primary care physician will treat the patient and give referrals to the specialist so the unnecessary extension of services will be avoided. This reduces the health care cost and improves health care services. The member has to spend out of pocket in rare situations. For ex: Patient most of services has been covered and there is no need of waiting time in case of the preexisting condition. The member has to pay deductibles once the coverage has started. It covers preventive services such as immunization and health check thereby improving health care. The physician will also get a fixed payment and will retain for a long time.

But the HMO will increase the power of physician power and physician dominant will arise. It increases the competition in health care delivery which improves the health care services. It benefits the healthier by promoting the preventive services which reduce the number of diseased states. Members are more involved in preventive services because of the coverage. Lowers the out of pocket expenses so it benefits the poor people. It satisfies financially both the physician and member and improves the quality of health care overall.