Health Management Organizations HMOs

Managed healthcare systems also have interests in reductionist definitions of disease. The payment and reimbursement structures of Health Management Organizations (HMOs) require that conditions be identified and coded in terms of a predefined list of syndromes with pre-established measures of cost and risk. Calling for evidence-based medicine , HMOs are more likely to reimburse conditions that are defined as biological because diagnosis appears objective. 

The U.S. Supreme Court in June 2004 imposed restricted litigation against Health Management Organizations (HMOs). Could further restrictions on the extent of permissible litigation be beneficial ... 

Drug Topics. Montvale, NJ Advanstar Medical Economics Healthcare Communications. Semimonthly. ISSN 0012-6616. Informational articles on all phases of pharmacy for community and health-system pharmacists, Health Management Organization (HMO) and consultant pharmacists, chain headquarters executives and buyers, mail-order pharmacists, wholesalers, academia, and others. 

Fig. 1 Health maintenance organization enrollment in the United States. (From Hoechst Marion Roussel Managed Care Digest Series /HMO-PPO Digest 1999.)...

Health maintenance organizations are the most restrictive type of managed care organization, and consumer dissatisfaction with restricted choice in HMOs likely was a significant factor in the growth of point of service (POS) plans. POS plans sometimes are referred to as open-ended HMOs. Like HMOs, enrollees typically select a primary care provider and pay no fee or a small copayment to see participating providers. POS plans differ from HMOs in that patients can receive coverage from physicians outside the network. However, patients pay more for care received from physicians outside the network and often must pay the full... 

Managed care is an umbrella term for HMOs and all health plans that provide health care in return for preset monthly payments and coordinate care in a defined network of primary care physicians and hospitals. A network includes physicians, clinics, health centers, medical group practices, hospitals, and other providers that a health plan selects and contracts with to care for its members. An HMO is an organization that provides health care in return for preset monthly payments. Most HMOs provide care through a network of physicians, hospitals, and other medical professionals that their members must use in order to be covered for that care. 

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