MANAGED CARE CONTRACTS BETWEEN HMOS AND PHYSICIANS
This research paper deals with contractual relationships between physicians and health maintenance organizations (HMOs) in the United States, including the factors which led to their creation, their nature, types and terms, the issues which flow from their application and their consequences for achieving overall social goals of access, quality and efficiency of health care.
Managed care provided through HMOs and other health care organizations plays an increasingly important role in the delivery of health care in America. The rapid growth of HMOs in recent years came in response to the inadequacies of the existing system for delivering health care, especially the failure of health care providers to operate efficiently, the resulting cost burden on the American middle class and the lack of access of the poor, the chronically ill and the aged to decent medical care. Managed care plans hold forth the promise of reducing the costs of health care and improving its quality for their middle class enrollees. HMO's are off to a good start in achieving cost containment. However, they cannot and should not be expected to solve the lack of access to medical care of many, which must be solved through government action, a political consensus for which has been lacking. The stipulations in contracts between HMOs and physicians and other health care providers and the way those contracts are administered in a system of corporate medicine are inevitably reducing the autonomy of physicians and may to some extent be aggravating the lack of access of significant segments of the population to adequate health care and placing health care providers and some patients in an unenviable position.
The practices of some HMOs have triggered private and public controversy over whether they truly represent progress toward the national goal of improving the delivery of health care to different segments of...