Talk:Health maintenance organization

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)

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)

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$

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)

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)

This article has no criticism of the HMO system, nor does it compare it with a public option. If Wikipedia is supposed to inform, then it it is either being deliberately being manipulated to avoid those hot topics, or the amount of editing contributions have fallen so dramatically that no one cares about this topic now under the general scrutiny over health care reform. In any case, as is this article is a shame to Wikipedia. 70.253.79.105 (talk) 04:50, 19 September 2009 (UTC)

so as i do — Preceding unsigned comment added by 182.71.81.206 (talk) 23:58, 6 July 2012 (UTC)

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)

I agree. This comment is terrible. You can't really regard an HMO as a monopoly, because it isn't. There is plenty of firms in the marketplace. You could argue that HMOs engage in monopolistic practices. The contracts signed by hospitals make it difficult to get health services without some sort of insurance. Most employers often only offer insurance from one company (though chances are your employer shopped around). Adding "Some critics regard" to the front of this sentence doesn't make it okay to write uncited biased stuff like this on wikipedia. For now I will remove it as it is adding nothing as is. Anythingapplied (talk) 00:16, 30 March 2009 (UTC)

I agree and "some" is a horrible word.

"You can't really regard an HMO as a monopoly, because it isn't." I absolutely do not like the word "really" either, so I'm going to presume you are saying "You can't regard an HMO as a monopoly". Cause either you can or you can't, "really" is just as bad as "some". Would be nice to have some info on why it isn't too, other than your judgement.

Also it's abit confusing how it can, as you said, be argued that it works like a monopoly but without being one. Seems contradictive.

213.141.89.20 (talk) 18:56, 24 May 2009 (UTC)

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)

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.

That is only true of you believe that insurance companies have an active role in risk reduction and mitigation, for example by insurers offering fire insurance setting up fire companies to fight fires and establishing building codes and zoning to prevent fires. Mulp (talk) 00:24, 13 June 2008 (UTC)

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)

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)

You'll find in general that Progressive ideas (i.e. the status quo) rarely are subject to criticism sections on Wikipedia, whereas everyone else who disagrees with Progressives will have long, dominating criticism sections. This is one problem with Wikipedia in general that really needs to be worked out. Ron Paul, the libertarian physician, in particular has some pointed criticisms of the HMO act of 1973 and how it made medicine so much more costly because HMOs would start telling doctors that they had to perform all kinds of additional tests which cost more and wasted more time. JettaMann (talk) 19:22, 29 June 2008 (UTC)

Uhm, that made no sense to me. You just said "that Progressive ideas (i.e. the status quo) rarely are subject to criticism sections on Wikipedia". Isn't progress the absolute opposite of status quo?

"Progressivism is a political and social term that refers to ideologies and movements favoring or advocating progress, changes, improvement, or reform, as opposed to wishing to maintain things as they are." - Wikipedia

I also don't think it's suitable to call HMO's a progressive idea to begin with. Also, I don't agree with your generalisation of wikipedia pages representation.

213.141.89.20 (talk) 18:40, 24 May 2009 (UTC)

"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)

Why does it need a "worldwide view"?

Wwhat good is an explanation of something that is primarily US going to be for someone who is in China or Antarctica? Are other articles bound by this as well? —Preceding unsigned comment added by 216.54.22.188 (talk) 04:03, 7 September 2008 (UTC)

Yes, I think it does need a "worldwide view", HMO are a US answer to a worldwide issue, and to compare it with other solutions given abroad is clearly a good idea. HMO is not the only natural and simpler answer to the question. Christian.Mercat (talk) 09:03, 10 September 2008 (UTC)

"Capitated reimbursement"

I am newly researching this topic. I note that Medical Economics Magazine discusses "capitated plans" and the like at length. Article cited is faulted for few references, so I point to it. —Preceding unsigned comment added by Cgmusselman (talk • contribs) 07:17, 31 March 2009 (UTC)

need some help with the Case management (USA health system)

this article on case management needs some expert attention please. I have recently started a Case management (disambiguation) page as the there are other case management terms, including a more general term medical case management Thanks for help Earlypsychosis (talk) 08:35, 2 July 2009 (UTC)

Image: California OPA Health Care Quality Report Card on HMOs for 2009

I just uploaded File:California_OPA_Health_Care_Quality_Report_Card_-_HMOs_-_2009-PD-CAGov.jpg :

Editors might want to add it to

• Health_maintenance_organization and/or
• America’s Health Insurance Plans
• Health insurance in the United States
• Managed care

--Elvey (talk) 09:08, 23 October 2009 (UTC)

Utilization Review vs Utilization Review

There is one sentence like this: "HMOs also manage care through utilization review." From Utilization_management page it looks like "Utilization management" is the better term. --Baijum81 (talk) 11:30, 3 December 2009 (UTC)

Definition?

After reading the article, it is still quite unclear to me what separates HMOs from other healthcare plan providers. (Besides the legalistic answer of "being certified as such", which still leaves me in the dark about requirements for certification.) The de:Health_Maintenance_Organization article claims the defining characteristic is that _practitioners_ get paid a fix amount per insured person in their area (and thus have a financial incentive to keep them healthy). Whereas in other forms, _insurers_ have this incentive, and practitioners are paid per-treatment. If that is actually true, it should be exposed prominently. If not, someone needs to figure out what the difference is, and explain it (and the de: entry should be fixed). Thanks! 46.114.1.188 (talk) 06:41, 12 November 2014 (UTC)

US-only?

I thought HMOs were something that the UK was pround of, and of course many other countries have had HMOs long before 1973. Is there an article under a different name for this? It's strange to see this generic term as US-only. —Ynhockey ^(Talk) 22:00, 24 June 2015 (UTC)

Exactly! I thought is suppose to be a global article. Sokuya (talk) 20:09, 12 January 2021 (UTC)

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