health maintenance organization


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health maintenance organization

(HMO), type of prepaid medical service in which members pay a monthly or yearly fee for all health care, including hospitalization. The term "health maintenance organization" was coined by a health policy analyst, Dr. Paul Ellwood, in the early 1970s. Most HMOs involve physicians engaged in group practice. Because costs to patients are fixed in advance, preventive medicine is stressed, to avoid costly hospitalization. One criticism of HMOs is that patients can use only doctors and specialists who are associated with the organization. Many people who have had a long-standing relationship with a family doctor or specialist have balked at what they see as a limitation of choice. "Open-ended" HMOs offer members the option of seeing a doctor who is not part of the HMO, but the patient must pay additional costs. Proponents of HMOs say that they make health care available to more people and that their emphasis on prevention results in earlier diagnosis and increased health-care savings. Numerous complaints (and lawsuits) have arisen, however, over HMOs' refusals to approve various treatments, and over the concern that the organizations skimp on care in order to realize profits. By 1996 most states had enacted laws restricting HMO rules that were seen as detrimental to patients' health. In 1997 there were 66.8 million Americans enrolled in HMOs. See also health insurancehealth insurance,
prepayment plan providing services or cash indemnities for medical care needed in times of illness or disability. It is effected by voluntary plans, either commercial or nonprofit, or by compulsory national insurance plans, usually connected with a social
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; managed health caremanaged health care,
system of health-care delivery that aims to control costs by assigning set fees for services, monitoring the need for procedures such as tests and surgical operations, and stressing preventive care.
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References in periodicals archive ?
The health maintenance organization, which has 5 million members statewide, has 33,400 members in Ventura County.
Kaiser, the nation's largest health maintenance organization with some 8 million members, also has been growing through acquisitions and start-up operations in cities around the country.
is a physician-sponsored not-for-profit health maintenance organization focused on preserving the community's access to quality, affordable health care.
Over the last 18 months, at least 34 states have outlawed or curtailed methods that many health maintenance organizations have used to shorten some types of hospital stays, discipline physicians or keep patients in the dark about the incentives and ground rules of managed care.
Neighborhood Health Plan (NHP) is a not-for-profit health maintenance organization serving MassHealth and commercial members across Massachusetts.
com), an Arkansas health maintenance organization (HMO), serves more than 140,000 members with a network of 92 hospitals and more than 5,000 physicians and other health-care providers.
A not-for-profit, state-certified Health Maintenance Organization (HMO), Scott & White Health Plan is part of the Scott & White Integrated Delivery System.
host of cable Television show Today's Health) is an extremely practical primer to the financial lingo of healthcare plans, Health Maintenance Organizations (HMOs), Medicare and Medicaid, coverage for those in the military, COBRA, and much more.
A Comparison of the Treatment of Rheumatoid Arthritis in Health Maintenance Organizations and Fee-for-Service Practices.
The HMO/PPO Directory is a comprehensive source that provides detailed information about Health Maintenance Organizations and Preferred Provider Organizations nationwide, including key contacts.

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