health maintenance organization


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Related to health maintenance organization: preferred provider organization, Health Maintenance Organization Act of 1973

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 ?
Such is the cynicism and mistrust of health maintenance organizations and the managed-care industry.
The approval means affordable, high-quality healthcare is available to consumers in the Charlotte area through Aetna's health maintenance organization (HMO).
HIP/Rutgers Health Plan is New Jersey's largest multi-specialty not-for-profit health maintenance organization with nearly 175,000 members statewide.
The county must get in step with the times by enrolling people who are eligible for Medi-Cal - mostly welfare recipients and working people with very low incomes - in health maintenance organizations affiliated with the county's Community Health Program.
The company's existing health maintenance organizations include Compcare, Wisconsin's oldest commercial HMO, and Valley Health Plan, a joint venture with the Mayo Clinic in the western part of the state.
Selevan added that a similar program would begin in the Coachella Valley, where there were too few patients for the health maintenance organization to build a facility, but enough to warrant creating a network of affiliated health-care providers.
is a physician-sponsored not-for-profit health maintenance organization focused on preserving the community's access to quality, affordable health care.
Neighborhood Health Plan (NHP) is a not-for-profit health maintenance organization serving MassHealth and commercial members across Massachusetts.
which runs California's HealthNet health maintenance organization and serves 2 million people in eight states, or WellPoint Health Networks Inc.
Best has upgraded the FSRs to A (Excellent) from B++ (Very Good) of GHS Health Maintenance Organization (GHS HMO) and Member Service Life Insurance Company (Member Service Life).
Health Advantage, the largest and oldest health maintenance organization (HMO) in Arkansas, will process claims for more than 140,000 members using AMISYS Advance.
A not-for-profit, state-certified Health Maintenance Organization (HMO), Scott & White Health Plan is part of the Scott & White Integrated Delivery System.

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