The 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 at which medical spending in the United States has been growing. Does it matter that 100 years after Lincoln freed the slaves that we have found another way to trade lives for money? HMOs have introduced an innovative way to provide health services: incentives for doctors not to treat patients. The less a physician practices, the more the company makes. HMOs make money by not providing a product. (Physicians Who Care, Internet 1999).
What exactly is an HMO? HMO is an acronym for health maintenance organization. An HMO is an organization that provides comprehensive health care to voluntarily enrolled individuals and families in a particular geographic area by member physicians with limited referral to outside specialists and that is financed by fixed periodic payments determined in advance. (Merriam-Webster’s Dictionary-1996) Sometimes considered a new concept, HMOs have been around since the 1930s. The difference today is that consumers are being nudged into them by their employers, in an attempt to hold down costs, and out of traditional insurance plans, in which the insurer reimbursed the patient directly and covered most of the cost of medical treatments. To encourage consumers, the HMOs promote their preventative services. Since the HMO has the patient’s money up front, it is important for them to keep the patient healthy. (Sinclair Community College-1999) An HMO can also be described as what seemed like a good idea at the time, but quickly became a concept out of control, thanks to medical bureaucracy, and just plain greed.
At the beginning of the 1990s, there were nearly 600 HMOs across America and they were regarded as a practical alternative to escalating medical costs. By 1998, it was clear that HMOs were out of control, leaving a trail of angry and neglected patients in their path. Physicians have also begun speaking out against HMOs in increasing numbers. According to Dr. Daniel J. Esposito, the main problem with HMOs is that, "there are no economic incentives to take care of people. The incentive is not to do anything" ("More Trouble With Managed Care" PG).
What happened? How could something, which started out so promising, have gone so terribly wrong? In a survey conducted by Harvard University in conjunction with the Kaiser Family foundation, it was revealed that 51 percent of Americans polled believe that HMOs are responsible for the deteriorating quality of their health care. Fifty-five percent expressed concern that HMOs were...