Each patient is a unique individual who merits an appropriately tailored process of care (Sanderson, 1995). Growing participation in HMOs may result in reduced quality of medical consideration. Advantages and disadvantages of HMOs are reviewed. Problems, alternatives, and implications for health administration within the HMO system are discussed.
Concerns over growing health care costs have resulted in alternative delivery systems advocating managed care. Percentage growth in health maintenance organization (HMO) membership throughout the 1980s was 32 million or 13 percent of the United States population. The HMO industry continues to experience difficulties and criticisms from physicians, the business community, third party payors, Congress, federal regulators, hospital executives, labor unions, and patients. Deficiencies are listed as low quality, poor management, interference with physician autonomy, inability to contain costs, lack of access to the poor or elderly, and restraint of trade (Widra & Fottler, 1992).
Advantages and disadvantages of HMOs are listed. Advantages include the following: medical costs are decreased; preventative medicine is provided without additional cost; all treatments, hospitalizations, and medications are provided with no or minimal fee; primary care physicians can be selected; and the potential exists to provide care to everyone in the United States. Disadvantages include the following: patients must first see the primary physician who makes decisions regarding tests, referrals, and consultations and the income of this gatekeeper is inversely proportional to the number of tests and consultations ordered; patients cannot get a second opinion without approval; patients with chronic or complicated diseases are subjected to frustrations or delays or denials of treatment; allotments of ten minutes per patient visit accommodate volume; examinations are performed with a lack of training; and...