Contractual Relationships between HMOs & 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

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r end offer lesser benefits for patients who are only able to pay lower premiums out of their own resources and subsidies provided by government. In such HMOs, Byron says that "you get a kind of supermarket run-through operation, one step above Medicaid" (1994, p. 14). There is some research which suggests that "patients who were elderly and poor were more than twice as likely to decline in health in an HMO" than in a fee for service plan (Pear, 1996, p. E2). Given the current financial crisis of Medicare and Medicaid, some other social remedies are necessary to protect the poor against the consequences of catastrophic illness. HMOs cannot fill this gap alone. 2. Discrimination in the selection and retention of physicians. Another way for HMOs to limit the number of high risk enrollees is to refuse membership in their plans to the physicians which serve them. Most likely to be adversely affected by such restrictions are physicians who practice in community health, maternal, mental health, rural health and family planning clinics. Altman & Wallack say that such providers "see a higher proportion of patients with costly and difficult health problems" (1995, p. 128). Such restrictions are generally applied retrospectively not prosp
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Some common words found in the essay are:
Ensor Berenson, Leatherman Fisher, Altman Wallack, HMOs United, Physicians HMOs, Iglehart Physicians, Rodwin Managed-care, Kennedy Johnson, Practices Schine, Health Net, health care, managed care, care plans, managed care plans, medical care, care system, primary care, health care system, health care costs, physicians 1994, care costs, altman reinhardt, england journal medicine, england journal, iglehart physicians 1994,
Approximate Word count = 6000
Approximate Pages = 24 (250 words per page)

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