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Mark Miller ENG 101 December 2, 2000 HMO Regulation Health Maintenance Organizations, or HMO?s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients. But it seems to the naked eye that instead their main goal is to get more people enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMO's, profit comes first- not patients' lives.HMO?s are groups of doctors hired by insurance companies and are usually controlled or regulated by the hospitals who facilitate them. The majority of this limitation is due to pressure from within the organization or government pressure. The government influences hospitals into denying treatment in order to cut federal costs. These government actions generally result in a revision of private employee health care claims, and in turn certain businesses can no longer afford to provide health insurance for their employees. Consequently, approximately 50 to 60 million people go without insurance for at least one month each year. Many HMO?s constantly evaluate their services to "ensure" the best care and coverage. But in many cases, what is happening is the exact opposite.HMO's can and do conduct their business quite ruthlessly. Patients are continuously unable to receive the necessary treatment due to the insufficient HMO coverage. Many HMO's actually make more money if their doctors see or treat fewer patients. According to the Associated Press, ?Consumers who have been denied a treatment that the HMO says is not covered, or who inadvertently fail to follow HMO guidelines in seeking treatment and are therefore denied reimbursement, will continue to have little recourse.? (2) Many people must drive for hours, generally sick or injured, simply to receive treatment from a doctor that will be covered by their HMO.Another downfall to HMO coverage is selective-contracting. This is a process where hospitals deny treatment to patients because their HMO is not on the hospital?s provider list. Doctors repeatedly turn away patients, even those with severe ailments, simply because if they were to treat them, then the cost for this treatment would come out of the physician's own pocket. Thomas Bodenheimer said, ?Selective contracting is common in managed care throughout the United States. It was created so that managed care could negotiate discount prices for physician, ancillary, and hospital services.? (3) But in fact selective contracting is used only to restrict doctor availability and in turn raise profits for the...

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