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)
[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) -cost 2500$
[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. 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)
[edit] Criticism
Right now the article only states: "Some critics regard HMOs as monopolies that distort the market for health care." I think that is a valid statement, but could someone perhaps expand on it? It would be nice to have a bit more explanation on the why and how, along with some sources. I get the impression that this is a very important point of criticism for some (if not many) Americans, so it would be nice to be able to read more about it. Thanks! —The Wild Falcon 08:26, 24 May 2007 (UTC)
When Michael Moore's new film Sicko goes into wide release there is going to be a firestorm of hits on this wikipedia page, with a primary interest being on the criticisms leveled against HMOs. A criticisms section, which should be in the article in any case, has cause for urgent development.
The operations section in particular does not address any of the disadvantages of the HMO system. While it discusses the advantages that HMOs can offer customers (ex: lower premiums), and mentions the incentives for PCPs, it does not discuss the disadvantages of this practice. For example, the disincentive to provide care on a fixed-payment system. ~~FM
I second the above statement. I think the explanation of what an HMO does is just a bit too friendly and positive, only playing onto what the good things are that HMO's do. In my opinion, the bad far outweighs the good (though being Wikipedia, that's somewhat irrelevant). Nevertheless, this article needs to have a view that is balanced with fact, which it currently sorely lacks. ~~ Sweetandy 07:34, 7 August 2007 (UTC)
Agree this article needs to specifically and thoroughly address the drawbacks of an HMO system. - JC —Preceding unsigned comment added by 24.183.97.16 (talk) 06:57, 19 February 2008 (UTC)
[edit] Sources of Information
This article needs a rewrite and statements like "Some critics regard HMOs as monopolies that distort the market for health care." need to be removed or expanded into a seperate section. No citations are given for this article. Tmursch 07:20, 27 June 2007 (UTC)
[edit] Regulation of HMOs (missing section?)+1
May I also request someone more capable than myself to contribute to this important fact about HMOs. In light of the perception of the "evil" capitalism role in Health Care in the United States, government indeed plays a HUGE role in the current system of HMO health care. From the creation of HMOs through state sponsored loans (tax dollars reaped from public coffers), to the regulation and certification processes. Without this intervention, it seems business partnerships free of government intervention would take place, and more flexible and inviting group style health care could take place. To say that the failure of, or criticisms of, HMOs are a result of free market forces is like saying that the US economy, is doing poorly because of free market forces. It is doing poorly if ever, because of government intervention that encroaches the free market aspect of it. Propping up undeserving business alliances that are garnered through coercion between big business and corrupt government officials is the current business model of HMOs, and other businesses like utilities, for example. Naturally, this is my opinion, but I hope that some points could be addressed in a non biased way here. 116.50.136.2 04:10, 19 August 2007 (UTC)
I am an MD JD. Having devoted several years to the study of HMOs, I know a great deal about them, and am an unabashed critic. Rather than transfer the massive amount of information to Wikipedia from my webpage (about 800 files, 64 MB), I would like the assembled members consider whether I should instead add a link to it. And/or I would also be willing to transfer entire sections to wikipedia, if that is considered acceptable. The page is www.harp.org. I would appreciate a heads-up at hsfrey at harp dot org if anyone posts a response to my offer. 71.189.251.41 20:45, 13 October 2007 (UTC)
[edit] Why put this under Medicine rather than Insurance?
While HMOs are certainly closely associated with health care, and can affect its delivery, they are fundamentally financing mechanisms. It would seem to me more appropriate to treat this as an insurance topic rather than a medical topic.
[edit] Rename Health Maintenance Organizations in the US?
Almost all of the content here deals with HMOs as they've developed in the US, except the recent addition of a paragraph on Switzerland. We could try to generalize the article, but I'm not sure how that would look. Are HMOs that prevalent outside the US? If not, perhaps we move this to make it an article on Health Maintenance Organizations in the US, and create a separate one on HMOs in Switzerland. We could tie the two together with a definition of what an HMO is, and links to countries that use them, in the general article on Health insurance.EastTN (talk) 16:22, 28 February 2008 (UTC)
[edit] No Criticism Section?
I find it surprising that this topic doesn't have a criticism section. Many other topics that provoke debate to have such sections. You need only look to the fact that there 's an NPOV label to point to the need for a criticism section. 122.167.194.234 (talk) 14:21, 29 April 2008 (UTC)
[edit] "California HMO Basics"? =
And this description is different from a "regular" or "non-California" HMO exactly how? 216.201.119.71 (talk) 19:10, 29 May 2008 (UTC)
