Health Maintenance Organizations as an Instrument for Cost Containment Policy

Health Maintenance Organizations as an Instrument for Cost Containment Policy
Author: Sinclair B. Coleman
Publisher:
Total Pages: 48
Release: 1979
Genre: Health maintenance organizations
ISBN:

A health maintenance organization (HMO) is any public or private organization that provides a comprehensive range of health care services, either directly or under arrangements with others, to an enrolled population for a fixed prepaid per capita fee. The basic health services that HMOs provide to their enrollees include physician services, inpatient and outpatient hospital services, medically necessary emergency health services, treatment and referral services for alcohol or drug abuse, laboratory and radiologic services, home health services, and preventive health services. Policymakers at all levels have argued for the expansion of HMOs and recently a new Office of Health Maintenance Organizations was established within DHEW to promote the HMO concept. It is generally believed that HMOs are a less costly method of delivering health care than the traditional fee-for-service system. Lower rates of hospitalization and surgery appear to account for the cost savings. The evidence generally supports the view that HMOs reduce costs but the effects on costs vary with the organization of the HMO and the practice setting.

Fads, Fallacies And Foolishness In Medical Care Management And Policy

Fads, Fallacies And Foolishness In Medical Care Management And Policy
Author: Theodore R Marmor
Publisher: World Scientific
Total Pages: 170
Release: 2007-03-28
Genre: Business & Economics
ISBN: 9814472980

No one misses the onslaught of claims about reforming modern medical care. How doctors should be paid, how hospitals should be paid or governed, how much patients should pay when sick in co-payments, how the quality of care could be improved, and how governments and other buyers could better control the costs of care — all find expression in the explosion of medical care conference proceedings, op-eds, news bulletins, journal articles, and books.This collection of articles takes up a key set of what the author regards as particularly misleading fads and fashions — developments that produce a startling degree of foolishness in contemporary discussions of how to organize, deliver, finance, pay for and regulate medical care services in modern industrial democracies.The policy fads addressed include the celebration of explicit rationing as a major cost control instrument, the belief in a “basic package” of health insurance benefits to constrain costs, the faith that contemporary cross-national research can deliver a large number of transferable models, and the notion that broadening the definition of what is meant by health will constitute some sort of useful advance in practice.

Evaluating Health Maintenance Organizations

Evaluating Health Maintenance Organizations
Author: Perry Moore
Publisher: Praeger
Total Pages: 0
Release: 1991-08-26
Genre: Health & Fitness
ISBN: 0899305571

Rising health care costs consumed one-fifth of the economic growth in the United States between 1980 and 1987, and increased at a rate much greater than that of inflation. One of the ways in which the country is seeking to control these costs is through health maintenance organizations. With their emphasis on prepayment for comprehensive medical care, and their use of risk-sharing with providers, they represent a distinct change from traditional fee-for-service medicine. This book examines the growth and development of HMOs over the past two decades, detailing the success that they have had in controlling costs, and assesses the quality of care they provide to their 33 million current enrollees. Perry Moore begins his study with a brief survey of the health care crisis and HMOs, covering such topics as regulation versus competition and decreasing patient satisfaction. He then presents a detailed history of HMOs and a look into their future, an analysis of utilization and costs in these organizations, and an assessment of the quality of care provided. Subsequent chapters examine the interaction between HMOs and employers, physicians, pharmacists, Medicaid, and Medicare; the particular problems that are faced by HMOs in rural areas; the characteristics of preferred provider organizations and how they compare with HMOs; and issues of managed competition and cost containment as they will affect the future of HMOs. This timely work will be a most valuable reference source for professionals in human resources and benefits management, as well as for students in these and related fields.

Health System Efficiency

Health System Efficiency
Author: Jonathan Cylus
Publisher: Health Policy
Total Pages: 264
Release: 2016-12-15
Genre: Medical
ISBN: 9789289050418

In this book the authors explore the state of the art on efficiency measurement in health systems and international experts offer insights into the pitfalls and potential associated with various measurement techniques. The authors show that: - The core idea of efficiency is easy to understand in principle - maximizing valued outputs relative to inputs, but is often difficult to make operational in real-life situations - There have been numerous advances in data collection and availability, as well as innovative methodological approaches that give valuable insights into how efficiently health care is delivered - Our simple analytical framework can facilitate the development and interpretation of efficiency indicators.