What Are HMO Health Plans?
The Health Maintenance Organization refers to a system that provides comprehensive medical services for people who actively participate in a specific area after charging a fixed prepayment fee. In 1973, under the impetus of the United States Department of Health, Congress passed the "Health Maintenance Organization Act", thereby ensuring the institutional development of this form of medical insurance.
Health Maintenance Organization
Right!
- Chinese name
- Health Maintenance Organization
- Foreign name
- health maintenance organization; HMO;
- The Health Maintenance Organization refers to a system that provides comprehensive medical services for people who actively participate in a specific area after charging a fixed prepayment fee. In 1973, under the impetus of the United States Department of Health, Congress passed the "Health Maintenance Organization Act", thereby ensuring the institutional development of this form of medical insurance.
- Health Maintenance Organization (HMO)
- The advantage of HMO over other insurance plans is that the cost is cheap. After paying the insurance premium, participants only need to pay a small registration fee when they see a doctor, and basically do not have to bear other costs. HMO insurance plans provide medical services through specific medical institutions contracted specifically with insurance companies, and develop a series of rules to control expenses. In order to ensure more patients, medical institutions are also willing to sign contracts with insurance companies at discounted prices. This model allows HMOs to control medical insurance costs to a lower level, so it is welcomed by low- and middle-income people after its launch.
- However, the cheapness of HMO also brings some disadvantages. In order to control costs, HMO stipulates that the doctor or medical institution that the insured person visits must be designated by an insurance company and strictly limits the scope of medical services. Therefore, disputes caused by medical delays often occur and legal proceedings are caused.
- Although health maintenance organizations are becoming a new alternative to traditional pay-per-service insurance, the idea of pre-paid health care goes back to the early 20th century, when sawmills and mill owners had organized themselves Prepaid group insurance. Their efforts led to the establishment of the Tacoma Western Clinic in Washington State, which provides comprehensive health care benefits at a reasonable monthly fixed price. Provide comprehensive coverage to the community and become the predecessor of the Kaiser Foundation Health Plans. Although competing with traditional insurance companies that support physician and hospital independence, third-party payments, and opposition from most regional medical groups, the ideas and behaviors of prepaid health plans have evolved slowly and steadily. By 1970, many prepaid health plans existed across the country. When the Federal Health Maintenance Act passed in 1973, prepaid health care was reliably supported and officially named. The Health Maintenance Act adopted by the Nixon Administration is a different approach to improving the health care system than the National Health Insurance. It serves several purposes:
- 1. Set standards, organize and provide financial support for HMO development;
- 2. Give HMO government approval in compliance with government rules;
- 3. Require employers to provide HMO insurance options for their employees.
- Subsequent amendments provide greater flexibility in the definition and requirements of health maintenance organizations. However, all of these bills are based on the HMO's principle of supporting free market competition and therefore help reduce health care costs without government intervention. The number of HMOs steadily increased during the 1980s and early 1990s, and it provided insurance to an increasing number of Americans. Many health care experts predict that by the end of the decade, half of Americans will participate in HMO or similar managed care.