Health maintenance organizations: structure, performance, and current issues for employee health benefits design.
After summarizing the origins and key principles of HMOs, including the current characteristics of the HMO industry, this article reviews the evidence of HMO performance in the areas of benefits design, utilization and cost effectiveness, quality of care and consumer satisfaction, and selection and overall employer satisfaction. Outstanding issues and concerns, from the perspective of employee health benefits design, include issues such as assuring a fair price for HMO benefits, employer contribution methods, HMO diversification, and cost escalation and the search for value. Results of research studies have been generally positive about HMO performance on benefits, cost effectiveness, quality, and consumer satisfaction, and more mixed on employer satisfaction. As employers address concerns, some changes are likely in the methods used to integrate HMOs into a health benefits strategy. Because the issues involved in these changes are numerous and complex, careful consideration and design are desirable to assure that the net impact of any change is positive and consistent with overall goals.
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Group Health Association of America Inc., Washington, DC 20036.
D003258:Consumer Behavior; D003362:Cost-Benefit Analysis; D006264:Health Benefit Plans, Employee / Q000191:economics*; D006279:Health Maintenance Organizations / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D011787:Quality of Health Care; D014481:United States