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At least 19 recordsLinked to original sources
PubMed1985

Utilization and coverage of mental health services in health maintenance organizations.

Health maintenance organizations (HMOs) generally have very limited coverage of mental health care and have been charged with shortchanging chronic patients in the interests of economy. The authors analyzed 1979-1980 coverage and utilization data from 53 federally qualified HMOs. They found that while coverage is limited and very similar across the spectrum of HMOs, utilization rates vary greatly and do not correlate with extent of coverage. They suggest that management decisions may be critical in determining access to and use of mental health benefits in HMOs.

Ambulatory Care↗
PubMed1979

When a solution is not a solution: Medicaid and Health Maintenance Organizations.

Health Maintenance Organization (HMOs) are repeatedly described as a general solution to the health care crisis and a specific solution to the problems confronting Medicare and Medicaid. The potential incorporation of HMOs into Medicaid has promised to improve the states' ability to accurately budget program expenditures, simplify management, eliminate abusive practices directly linked to fee-for-service (e.g., billing for undelivered services for providing unnecessary care) and, most important, contain costs. At the same time it has promised to increase access to mainstream medicine. Experience has shown, however, that the promise has often been severely compromised by unethical HMO marketing practices, inadequacy of services and excessive administrative costs. This article examines some of the reasons: the political process which created HMOs, the rhetorical claims which exaggerated the strengths of prepaid group practice and distorted the formulation of policy, and the peculiar characteristics of the Medicaid program which have caused Medicaid HMOs to deviate considerably from theoretical expectations.

Animals↗
PubMed1982

The future of health maintenance organizations.

Health maintenance organizations, though in existence since about 1940, gained nationwide attention in the early 1970s as an efficient system for delivering health care services. Though initially condemned by organized medicine as unethical, the HMO has today become a rapidly growing health care system, and one, according to the author, vital to the future of the private practice of medicine. The author sketches the history of third-party payers, and the role of the government in health care since the Depression and discusses its effect on private practice. The HMO, fostered by government action under the Nixon administration, is viewed as a pro-competitive wedge that will break the long-standing monopoly held by Blue Cross-Blue Shield, hospitals, and local medical societies. It is through the HMO or an HMO-like model that the future health care system will become more cost-effective, egalitarian, and accessible to those in need of services, the author says.

Cost-Benefit Analysis↗
PubMed1990

The ethics of selectively marketing the health maintenance organization.

Health Maintenance Organization (HMO) administrators have been accused of engaging in 'selective marketing'. That is, through such strategies as tailoring the benefits package of the program or advertising in styles or in media that do not appeal to certain 'undesirable' audiences, the administrator can minimize the percentage of persons in the HMO who are heavy users of health care services. By means of analyzing what 'insurance' is (philosophically) and what it means for something to be a free market commodity, the author argues that, as long as American society chooses to regard health insurance as a commodity or service of the free market. the use of such strategies is within the moral rights of health administrators. The author concludes by noting some morally undesirable results of treating health insurance as a market commodity.

Capitalism↗
PubMed1996

Enhancing preventive and primary care for children with chronic or disabling conditions served in health maintenance organizations.

Health maintenance organizations serve an estimated 20 percent of the child population, approximately 12 million children, many of whom have chronic conditions or disabling conditions. These children consume a disproportionate share of health resources and represent an important challenge in terms of care management. As HMOs increasingly enroll children with private insurance and Medicaid who have various physical, developmental, behavioral, and emotional disorders, they must find new and innovative ways to provide their care. Almost one third of children are affected by chronic conditions, and a smaller percentage (6 percent) suffer from chronic disabling conditions. Seven design elements for enhancing preventive and primary care for children with chronic conditions are presented in this article with illustrative examples from HMOs and state Medicaid programs.

Case Management↗
PubMed1991

Understanding and assessing service quality in health maintenance organizations.

Health maintenance organizations (HMO's) have been one of the major innovations in providing healthcare. However, as the HMO enjoyed success as an alternative delivery system, competition among individual HMO's intensified. As a result, the 1990's will require continued attention to the effective delivery of quality services to clients. Providers of healthcare services must work toward establishing a strong competitive position in the marketplace which means that they will have to understand how their customers perceive value in the services rendered. The authors examine exchange relationships that occur in the HMO and offer an approach for analyzing the dimensions of service quality demanded by the HMO's constituents. Practical ways to enhance service quality are discussed.

Consumer Behavior↗
PubMed1983

Health maintenance organizations; Health Central--Health Resources and Services Administration.

On October 29, 1982, the Office of Health Maintenance Organizations (OHMO) notified Health Central, 17th and N Streets, Lincoln, Nebraska 68508, a federally qualified health maintenance organization (HMO), that Health Central had successfully reestablished compliance with its assurance to the Secretary that it would maintain a fiscally sound operation. This determination took effect on October 1, 1982.

Health Maintenance Organizations↗
PubMed1983

Health maintenance organizations; North Central Connecticut Health Maintenance Organization--Health Resources and Services Administration.

On August 10, 1982, the Office of Health Maintenance Organizations (OHMO) notified Kaiser Foundation Health Plan, Inc. (KFHP), One Kaiser Plaza, Oakland, California 94612, that North Central Connecticut Health Maintenance Organization (NCC/HMO), 99 Ash Street, East Hartford, Connecticut 06101, a federally qualified health maintenance organization (HMO), had successfully reestablished compliance with its assurances to the Secretary that it (1) maintain a fiscally sound operation, (2) maintain satisfactory administrative and managerial arrangements, and (3) obtain the required contractual provisions with health professionals providing basic health services to its members. The reestablishment of compliance took effect on July 1, 1982, and was based primarily on the completion of an agreement between NCC/HMO and KFHP under which KFHP assumed the operation of NCC/HMO. This notice also reports a name change for NCC/HMO to Kaiser Foundation Health Plan of Connecticut, Inc. (KFHPC).

California↗
PubMed1994

Health maintenance organizations, health care reform, and persons with serious mental illness.

Implementation of the Clinton Administration's proposed Health Security Act could significantly increase the number of seriously mentally ill persons enrolled in health maintenance organizations (HMOs). Studies of the mental health status and outcomes of seriously mentally ill persons treated in HMOs show conflicting findings and provide little guidance about the likely effect of the Health Security Act on this population. However, implementation of the Health Security Act would be likely to influence the treatment of seriously mentally ill persons by altering the activities of state and local governments in the financing and delivery of care, facilitating the integration of public and private services, and encouraging development of additional service capacity. To clarify HMOs' likely role in providing services to seriously mentally ill persons under health care reform, more research is needed on the current service capacity of HMOs, on treatment approaches and outcomes in different HMO models, on whether seriously mentally ill persons would be likely to choose HMOs from among health plan options, and on whether higher-income HMO enrollees would seek care outside HMO provider networks.

Health Care Reform↗
PubMed1980

Public Health Service--Health maintenance organizations; requirements for a health maintenance organization. Final regulations.

This rule amends the Public Health Service regulations by setting forth revised requirements for the organization and operation of federally qualified health maintenance organizations (HMOs). These amendments are made as a result of (1) public comments on the interim regulations published on July 18, 1979, and (2) public comments on the notice of proposed rulemaking (NPRM) governing relationships between federally qualified HMOs and other parties, also published on July 18, 1979.

Facility Regulation and Control↗
PubMed1983

Health maintenance organizations; Midwest Health Plan--Health Resources and Services Administration.

On January 21, 1983, the Office of Health Maintenance Organizations (OHMO) notified Midwest Health Plan (MHP), 3415 Bridgeland Drive, Bridgeton, Missouri 63044, a federally qualified health maintenance organization (HMO), that MHP had successfully reestablished compliance with its assurances to the Secretary that it would (1) maintain a fiscally sound operation, and (2) maintain satisfactory administrative and managerial arrangements. This determination took effect on January 1, 1983.

Health Maintenance Organizations↗
PubMed1982

Health maintenance organizations--Public Health Service. Final regulations.

These rules amend the Public Health Service (PHS) regulations on health maintenance organizations (HMOs) by implementing certain changes made by the Health Maintenance Organization Amendments of 1981. The provision governing repayment of grant funds under certain circumstances is also amended. In addition, this rule amends the requirements for the award of loans or loan guarantees to qualified HMOs for the acquisition or construction of ambulatory health care facilities and the acquisition of equipment for those facilities (Subpart J). The amendments to Subpart J are made as a result of public comments on the interim regulations published on April 9, 1980.

Health Maintenance Organizations↗