Hmo - 1538 Words

HMOs: The Health Care of the Beast Many people are concerned about rising health care costs. In reaction to this, some individuals and companies are gravitating toward the assumed lower prices of Health Maintenance Organization (HMO) health plans. HMOs spend billions of dollars each year advertising their low cost services. While these savings look good on paper, there are many pages of small print. The explanation after the asterisk indicates that not only do the HMOs lack lower costs, but they also short-change the patient in quality care. Much of the money spent on premiums goes directly into the pockets of stockholders and less is then available for patient care. In addition, the main clinical decisions are made not by doctors,†¦show more content†¦HMOs are not the only answers to cost control. Most physicians practicing in the United States consider their profession to be very much a form of art (Kleinke). The definition of art infers that within its sphere there are many variations and preferences. Afte r all, one should not ask Picasso to carve like Michelangelo. Physicians too differ in their methods of treating patients. However when needless tests and procedures are done the treatment will cost more. This is waste. Many suggest that cutting waste will lead to a cut in quality. This is not necessarily true. Consider the following: an otherwise healthy forty-year-old male comes to a clinic complaining of a sore throat. This is a good nonspecific symptom, so naturally some tests are done. Some blood is drawn, a culture taken, and an electrocardiogram performed. An EKG in this case is not medically necessary, but many physicians still do not hesitate to order one. By eliminating useless procedures, lower cost can be maintained. To determine which procedures are useless, scientists would need to perform ongoing studies of patients that fall under their investigative categories. For instance, every year about 80,00 Americans get a carotid endarterectomy, aShow MoreRelatedHMO Regulati on Essay1431 Words   |  6 PagesHMO Regulation Health Maintenance Organizations, or HMOs, are a very important part of the American health care system. They involve elements such as beneficial health care programs like Medicare for seniors and Medicaid for the poor. HMOs are sometimes referred to as managed care programs, which involves participation through clinics, physicians and insurance companies. Other essential parts of HMOs include prescription drug plans, such as distribution and cost, and they are also importantRead MoreStaff Model Hmo vs. Group Model Hmo700 Words   |  3 PagesAshley Rassbach LP2: Staff Model vs. Group Model HMOs HMOs provide several benefits to both physicians and patients alike; however, both Staff Model HMOs and Group Model HMOs offer different types of benefits for both. Group Model HMOs are centered around multi-specialty medical groups that focus on the performance of the group as a whole; they tend to be a bit less structured than the Staff Model HMOs. Many Group Model HMOs have ties to hospitals in the areas in which they practice, butRead MoreHmo vs. Nhs2081 Words   |  9 PagesHMO vs. NHS HMO (Health Maintenance Organization) and NHS (National Healthcare Service) have been a controversial topic for many years. I watched a movie entitled, â€Å"Sicko.† It is a documentary that was written and directed by Michael Moore. The Documentary investigates the American health system and compares it to the National Healthcare Service in many other parts of the world. One of the countries that have socialized medical care sits directly above the United States. It is Canada. The horrorRead MoreEssay on The Problems with HMOs2418 Words   |  10 PagesThe Problems with HMOs It was no surprise when I interviewed my English class about HMOs, that out of 13 students, seven currently having HMO coverage, 77% felt HMO healthcare inferior to traditional insurance. This group closely represents the U.S. population, as HMOs have become practically synonymous with health care and the idea that Americans are no longer receiving the quality care they received from unmanaged plans. Managed care plans have succeeded in dramatically cutting the rate atRead MoreEssay on Hmos: Making A Killing1045 Words   |  5 Pagescare system. It is a program that would cover Americans from â€Å"the cradle to the grave†. In our current system, hundreds of billions of dollars go to insurance company overheads, unnecessary administration costs, huge profits, high salaries at bloated HMOs, and other for-profit health care companies. Studies have proven that the money saved by the cutting the previously mentioned wastes would be sufficient to provide universal coverage for t he amount we are now paying for our current, inadequate systemRead MoreSuccessful Patient Centered Medical Homes And Hmos1450 Words   |  6 Pages Successful Patient Centered Medical Homes and HMOs Richard Jenkins Trident University â€Æ' Abstract There are various models designed to enhance the quality of health care provided in today’s society. Within the health care system the objective is to provide quality care to the patient is the primary goal, however, over time due to such a strong concentration on this objective expenses have been forgotten. Medical care has now grown to a ridiculous expense. Congress, medical professionalsRead MoreStatistical Thinking in Health Care-Hmo. Essay1051 Words   |  5 PagesStatistical Thinking in Health Care Case Study 1 Week 4 Mat 510- Business Statistics November 1, 2015 With information from the case we will attempt to address some explanations to the issue of medication errors being dispensed at HMO pharmacy. A dispensing error is a discrepancy between a prescription and the medicine that the pharmacy delivers to the patient or distributes to the ward on the basis of this prescription, including the dispensing of a medicine with inferior pharmaceuticalRead MoreChesapeake Health Plans : Hmo Financial Performance1140 Words   |  5 Pagesattributes a considerable portion of their net service revenue generated to their effective HMO health plans, which realized a 46% of total revenue, while their Medicare HMO produced an impressive 39% of total revenue. Furthermore, their Preferred Provider Plan (PPO) generated 10%, and the Point of Service Plan (POS) saw a 5% figure. This case study financial analysis will effectively assess Chesapeake Health Plans: HMO financial performance, focusing on a competitive analysis, a cash flow analysis, clearRead MoreHmo ( Health Management Organization ) Is A Preferred Provider Organization2120 Words   |  9 Pages215 â€Æ' HMO (Health Management Organization) is a preferred provider organization. Their focus is to reduce the cost of the preventative care as well as implementing utilization management controls as part of their goal. Being part of a HMO, you can choose the primary physician for medical purposes. One of the advantages are the low cost out of pocket costs for the patient’s insurance. Each time you seek medical care you are only obligated to pay a percentage of the bill. Members of HMO are at aRead MoreCase Study : The Ppo Model And The Open- Panel Hmo Model984 Words   |  4 PagesThe BCBS IL has been able to use its experience to catapult itself to the forefront of many MCO in the health care market, today the organization offers dual health insurance model to their beneficiaries; the PPO model and the open- panel HMO model. The Medical Of Structure: BCBSIL As has been denoted by the history of the BCBSIL above, the medical structure of BCBSIL is composed of providers that may, or may not have a contract with the BCBSIL. The contract with the providers or the modality of