Health Maintenance Organization
Health maintenance organization is a kind of organization that has a set of health insurances and coverage for a certain group of people. It is a specific type of health care plan, and it is a bit more famous than traditional insurance policies because it costs less. The reason for that is health maintenance organizations usually offer their services with fixed and prenegotiated prices. There is a prepaid contract between the organization and the subscribers. There are usually guidelines under which doctors can operate in health maintenance organizations, though there are a lot of health services and coverage they can give to the people who subscribe to them. Health maintenance organizations can be private or public.
Health maintenance organizations have been here since the beginning of the 20th century. It began when businesses and companies started offering their employees prepaid medical programs (since this would be cheaper for both the businesses and the people who need the programs). Health maintenance organization memberships began to decline in the latr 1960’s and early 1970’s until 1973, when the U.S. Department of Health and Human Services passed the HMO Act which would then help health maintenance organizations become a big part (yet again) of American health care.
Two main types of Health Maintenance Organizations
1. The Prepaid Group Practice – The prepaid group practice involves physicians who are organized into a group practice. For prepaid group practice there is only one insuring company or agency.
Examples: Ross-Loos Medical Group (California, US) – the group who started the prepaid group practice in 1929; The Kaiser Foundation Health Plan (California); Health Insurance Plan (Greater New York); The Group Health Cooperative (Puget Sound).
2. The Medical Care Foundation – unlike the Prepaid Group Practice, this involves more than one insurance companies.
Examples: San Joaquin Foundation (California); The Physician Association of Clackamas County (Oregon)
How Health Maintenance Organizations Work
Health Maintenance Organizations mostly focus on preventive medicine and other sorts of preventive measures. Upon joining the organization, members are asked to choose their primary care physician from the list which shall be provided by the organization. The primary care physician will sort of be like a family doctor to the member—the primary care physician will be in charge of dealing with the member’s medical condition(s). The physicians are also usually from the health maintenance organization, and it is actually more practical for the member to choose the physician from the organization because they will have to be responsible for their own fees if their physician is from out of the organization.