hmos takes the care out of health care

2869 Words6 Pages
bulb-icon

Recommended: Managed health care pros and cons

HMOs Take The ‘Care’ Out Of Health Care. In the early 1990s insurance companies, in attempt to control spiraling medical costs, created what would be termed “health maintenance organizations”, also known as HMOs. What HMOs do is create a team of physicians and medical personnel that the patients agrees to use. Within the contracts both the patient and the doctor sign, limits and restrictions are put on what the hospital will reimburse and what they will or will not provide in order to keep the costs down. At the beginning, these organizations were successful in bringing medical costs down and has made health insurance more affordable than ever. However, the contracts that the HMOs have you sign basically limits the doctor on how he or she can treat their patients, thus putting their job as the physician in the hands of the HMO. As profits began to go up and down these organizations have put more effort into keeping their costs down and have lost sight of actually caring fir the patients they are insuring. To prove my thesis in this paper I will discuss how our senior citizens and the chronically ill have been hurt by recent cuts their HMOs have made. I will discuss the many reports of HMO negligence and the issues concerning the patient doctor relationship. I will also go into what actions, or lack thereof, our government has taken in response to HMO woes. All of these points will show that HMOs have lost the concept for caring for their patients including our elders who are one genre that are being hit hard by the actions these HMOs have taken. In January of 2001, nearly one million senior citizens were kicked out of their Medicare health plan (“What’s Behind” 1). Why have so many HMOs dropped these health plans? The reason why is because these Medicare programs are for the elderly only and simply were not profitting, and in response, the insurance companies shut them down. The HMOs claim that federal reimbursement levels were not keeping up with the medical cost inflation forcing them to cut these programs. For instance, in 2001, the government’s reimbursement to the HMOs went up only 2 percent while the insurance company’s costs went up between 11 and 13 percent (par.3). Though the reimbursement level issues may have contributed to the HMOs decision to cut these pro... ... middle of paper ... ...ted high levels of stress associated with dealing the multiple agencies and healthcare providers. Since managed care’s beginning, the way medical care has been provided and delivered as drastically changed, and this trend is more than likely to continue. No one is going to be hit harder by these changes than the families who have children with complex chronic medical conditions. Work Cited Alleger, Irene. “HMO’s- Business Masquerading as Medical Care.” Towsned Letter for Doctors and Patients 215 (2002): 135. par. 9. Almanac of Policy Issues. “Universal Health Care Coverage.” March 29, 2005. American Medical Student Association. “Myths & Facts About Single-Payer Universal Coverage.” Marc.h 29, 2005 Canadian Health Care . “Canadian Health Care.” March 29,2005. “HHS:HMO’s Ignore Medical Incompotence.” International Council fpr Health & Human Services 5.21 (2001): 1-2 par. 17. Tuleya, R.J. “The HMO Dilema.” Nutrition Health Review: The Consumer’s Medical Journal 79 (1999): 3. par. 22. “What’s Behind the Medicare Woes?” People’s Medical Society Newsletter 19.6 (2001): 1-2 par. 7. Universal Health Care. “Summary of recommendations Poor Health and Homeless. March 29, 2005.

Show More
Related

  • Managed Care: An Overview and Its Uncertain Future

    1114 Words  | 3 Pages

    It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed One being the Health Maintenance Organizations (HMO), which was first proposed in the 1960s by Dr. Paul Elwood in the "Health Maintenance Strategy”. The HMO concept was created to decrease increasing health care costs and was set in law as the Health Maintenance Organization Act of 1973, after promotion from the Nixon Administration. HMO would, in exchange for a fee, allow members access to employed physicians and facilities. In return, the HMO received market access and could earn federal development funds.

    Read More

  • Medicare Part D

    1800 Words  | 4 Pages

    (II) The enacting of Medicare Part D in 2006 only helped to fuel America’s hunger for prescription medication. In 2003, President George W. Bush announced and signed the Medicare Prescription Drug, Improvement, and Modernization Act (also known as the Medicare Modernization Act, or MMA) on December 8th. The roughly $400 billion dollar measure was marketed to the American public as something that will provide care for the millions of senior citizens who, at the time, were struggling to afford prescription medication. This was the largest development of Medicare since 1965, which is when the program was initially created, and gave hope to those wishing for positive medical reform. According to title XI of the “Medicare Prescription Drug, Improvement, and Modernization Act of 2003”, the most significant change will be the affordability of prescription drugs by implementing the importation of drugs from Canada, along with necessary safety measures, in order to lessen the cost (United States Congress, 832). For those who were in retirement homes and lacked a steady income, the affordability of drugs was often a deciding factor in the decision to seek medical attention and the idea that those individuals ceased to live simply because they lacked the funds tugged at the heartstrings of many Americans.

    Read More

  • Managed Care Models Essay

    1380 Words  | 3 Pages

    Health Maintenance Organization (HMO) is a group of individual health plans that are intended to provide services for costumers’ that purchase insurance policies and for those that cannot afford health insurance. Many of these organization are led by physicians, and other professionals that network together to make health care affordable for patients. In the HMO category there are five separate managed care plan models. First, the Group Model (HMO), is a group that has a number of physicians that mainly agree to provide care to a defined group of patients in return for a fix rate capita payment for discounted fees from insurance companies (Henderson, 2012 p.212).

    Read More

  • The Pros And Cons Of Medicare Part D

    1538 Words  | 4 Pages

    Today, Medicare Part D is the most approved federal program celebrated as a government success. It is favored by federal programs in the United States of America and is said to be well under budget. Part D has its own advantages and disadvantages. This paper discusses the various stakeholders and their influence on the outcome of Medicare Part D, along with particular strategies and implications that were used to support this Medicare Part D legislation. It also focuses on the specific proposals that can invigorate the program to the low-income subsidy, transition from Medicaid to Medicare, the use of formularies and utilization management tools, Part D and long-term services and supports, and program quality (Kendall, D., 2013, November 05).

    Read More

  • Managed Health Care Issues

    3218 Words  | 7 Pages

    When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.

    Read More

  • HMO Regulation

    1302 Words  | 3 Pages

    Another downfall to HMO coverage is selective-contracting. This is a process where hospitals deny treatment to patients because their...

    Read More

  • Expanding Medicare to Include Prescription Drug Coverage

    2103 Words  | 5 Pages

    The question, however, is whether or not such drug coverage is a worthwhile project to undertake. Is the problem indeed serious enough to call for the type of reform that the candidates are proposing? Medicare is already a very costly program to keep up, and adding prescription-drug coverage would increase these costs even more. In order to fund this project, there will need to be a tax hike. Should taxpayers subsidize this prescription-drug benefit? Is there a good reason why this redistribution should take place? What are the benefits and costs of this proposal? These and other questions will be addressed in this paper as we examine the following topics: the need for senior citizens to have prescription-drug coverage, the political rhetoric involved with this issue, the projected shortfall in the budget of the Medicare program, and who really would benefit if a prescription-drug benefit was added to Medicare.

    Read More

  • The Necessity of the Affordable Healthcare Law

    2022 Words  | 5 Pages

    In America the affordability and equality of access to healthcare is a crucial topic of debate when it comes to one's understanding of healthcare reform. The ability for a sick individual to attain proper treatment for their ailments has reached the upper echelons of government. Public outcry for a change in the handling of health insurance laws has aided in the establishment of the Affordable Healthcare Law (AHCL) to ensure the people of America will be able to get the medical attention they deserve as well as making that attention more affordable, as the name states. Since its creation, the AHCL has undergone scrutiny towards its effects on the government and its people; nevertheless, the new law must not be dismantled due to its function as a cornerstone of equal-opportunity healthcare, and if such a removal is allowed, there will be possibly detrimental effects on taxes, the economy, and poor people.

    Read More

  • Profit-driven Tactics of Insurance Companies

    413 Words  | 1 Pages

    Health insurance companies are experts in setting traps for consumers to entice them into handing over a vast amount of money and not receive a single valuable service. After all there isn’t an entity available to regulate them.

    Read More

  • Third Party Payers In Healthcare

    650 Words  | 2 Pages

    Managed care reimbursement models have contributed to risk avoidance by negotiating discounts, discouraging use, and denying payments for charges that appear to be false. Health care reform has increased awareness to the quality of care providers give, thus shifting the responsibility onto the provider to provide quality care or else be forced to receive reduced reimbursements (Buff & Terrell,

    Read More

  • The Concept Of Health Managed Care

    1040 Words  | 3 Pages

    In order to keep health care cost down doctors, hospitals and insurance companies are encouraging patients to get exercise, watch their diets, keep active and have wellness and preventive medicine checks every six months or what your doctor suggest. For HMO plans you can only go to doctors, health care providers or hospitals that would carry this plan. So if you are thinking about doing the HMO plan, I would do some research on doctors to see what the doctor will take care of HMO and also check on their ratings to before you decided to go see that doctor(Health Maintenance Organization (HMO) Plan).

    Read More

  • The Medicare Problem

    2703 Words  | 6 Pages

    The two major components of Medicare, the Hospital Insurance Program (Part A of Medicare) and the supplementary Medical Insurance program (Part B) may be exhausted by the year 2025, another sad fact of the Medicare situation at hand (“Medicare’s Future”). The burden brought about by the unfair dealings of HMO’s is having an adverse affect on the Medicare system. With the incredibly large burden brought about by the large amount of patients that Medicare is handed, it is becoming increasingly difficult to fund the system in the way that is necessary for it to function effectively. Most elderly people over the age of 65 are eligible for Medicare, but for a quite disturbing reason they are not able to reap the benefits of the taxes they have paid. Medicare is a national health plan covering 40 mi...

    Read More

  • History of American Medicine

    1269 Words  | 3 Pages

    With the creation of Medicare in 1966 in order to expand access for the elderly to the American healthcare system, the ways in which medicine and its corresponding industries were conducted were irrevocably changed. Prior to its inception, only 65% of people over 65 actually had proper health insurance, as the elderly paid three times as much for healthcare as young people (Stevens, 1998). The private medical sector had much more control over who they would treat, how much they would charge, and more; the passing of Medicare freed up the elderly to have reasonable access to healthcare as a consequence of a lifetime of paying into the system.

    Read More

  • Fraud and Abuse in the Healthcare System

    913 Words  | 2 Pages

    Healthcare services have been on the rise for over 10 years now. According to a 2012 consumer alert, the industry provided $2.26 trillion in payments for more than four billion health insurance benefit claims in the year 2011(Fraud in Health Care). The bulk of the claims and the mainstream of fraud and abuse stem from the Medicare system professionals, who are knowledgeable about the process and persuade new clients into handing over their pertinent information in hopes of deception and illegitimate claims. Multiple and double billing, fraudulent prescriptions, are some of the major flaws in this organization that has made the healthcare services industry curdle. (AGHAEGBUNA, 2011) This is a non-violet crime and is often committed by very educated people including business people, hospital, doctors, and administrators.

    Read More

  • Reflection Of The Movie Sicko

    720 Words  | 2 Pages

    The movie Sicko evaluates the medical services and shows the U.S. government 's role in policing the medical profession. Before I watched this movie, I thought that living in America was living the American dream. However, this American dream is only a façade or an illusion that takes my mind away from some of America 's flaws. In this documentary, the director and writer Michael Moore exposes the dysfunctional health care system in the United States, which sacrifice essential health services in order to maximize profits and insurance companies, which pay bonuses to employees who are successful in denying coverage and claims. They are in the business of finding reasons not to spend money. Health insurance does not protect you from not paying.

    Read More

More about hmos takes the care out of health care

Open Document