Understanding different models of health maintenance organizations.
More than 50 million Americans belong to a health maintenance organization (HMO), and enrollment in all types of managed care plans continues to grow. To survive and thrive in the evolving health care system, independent and group practitioners find it essential to understand managed care. This article describes the key features and main characteristics of the most prevalent models of HMOs, as well as the role of physicians in each. It discusses the theoretical and practical benefits and drawbacks of HMOs, including financial and organizational relationships with physicians and other providers, variation in consumer choice, provider incentives, cost effectiveness, and management oversight.
Offner
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Harvard Pilgrim Health Care, Dedham, MA 02026-6127, USA.
Zacker
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D005249:Fees and Charges; D006279:Health Maintenance Organizations / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D015279:Organizational Culture; D012017:Referral and Consultation; D014481:United States