Hmos: Making A Killing

Fact: Currently, there are 46 million Americans who do not have medical insurance. Fact: The United States is the only advanced industrialized country in the world that does not provide health insurance to all the people. FACTS: Everyone in the US spends more on health care than any other country in the world. FACTS: The World Health Organization is ranked 37th in the world for health management of Americans. Fact: No country on the planet provides universal health insurance to all citizens under the private health insurance system.

Health Maintenance Organization (HMO) is a managed medical institution (MCO) that provides medical insurance through hospitals, doctors, and other health care providers contracted with HMO. The Health and Safety Organization Act of 1973 requires that employers hiring more than 25 employees provide Federal Government approved HMO options. Unlike traditional compensation insurance, HMO covers only the care provided by doctors and other experts who agree to treat patients according to HMO guidelines and restrictions in exchange for steady customer flow . Profit is provided through the provider network. A provider can be a member of an HMO employee ("staff model"), an employee of a provider group contracting with HMO ("group model"), or a member of Independent Practice Association ("IPA model"). HMO can also use these methods in combination ("network model").

Health Maintenance Organizations (HMO) - HMO can access specific physicians, clinics and hospitals in the network. To participate in the HMO program, you need to live in a specific service area or work. If you stay in the health care provider network, your health care is only covered by insurance. The third category of healthcare plan is the High Deductible Health Plan (HDHP). Compared with conventional health insurance plan, HDHP is simply a plan with high deduction. According to the US Internal Revenue Service, the health insurance plan has a personal deduction of at least $ 1,300 and a $ 2,600 family available for HDHP. (12)

In other words, HMO is an organization that places hospitals and doctors in the organization. Members pay a fee to use the HMO service per person. Unlike traditional health insurance and PPO (the second most popular managed care system), HMO conducts the necessary medical examination and provides primary care physician (PCP), which allows all medical professionals to see doctors, We ask participants to choose. It is clear that these HMOs are one of the two most popular managed medical networks. According to the latest statistics of the American Health Plan Association, 89 million Americans joined the HMO in July. In other words, more than 30% of the insured participated in the HMO. According to these plans, you need to pay a fixed amount for all medical treatment. You must use HMO doctors and facilities, all professional care must be approved by your PCP