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 ?
But they can all be categorized into four basic groups: traditional indemnity or fee-for-service plans, preferred provider organizations (PPO), point-of-service plans (POS) or health maintenance organizations (HMO).
Although not affiliated with a group practice, Wilkerson had a managed care contract with an HMO (health maintenance organization) subsidiary of Capital Care to provide medical care for federal government employees.
At the other end of the spectrum is the traditional health maintenance organization (HMO), in which a primary-care physician directs patient care within a network of pre-selected health-care providers.
Martinez of the University of Arizona College of Medicine in Tucson, tracked 826 children born between 1980 and 1984 and enrolled at birth in a health maintenance organization in Tuscon.
Health maintenance organization participants rose from 2% in 1980 to 19% in 1988.
managed care companies, with its health maintenance organization, point-of-service, insured preferred provider organization and government contract units providing health benefits to about 6.4 million people in 27 states and the District of Columbia through group, individual, Medicare, Medicaid and Tricare programs.
The predominantly white sample was recruited from a health maintenance organization in Michigan and contained more women than men.
Andrew Wiesenthal, associate executive director of the Permanente Federation, part of Kaiser Permanente, a nonprofit, group practice health maintenance organization, based in Oakland, Calif.
One health maintenance organization, with 15 different clinics and 50 primary care practitioners, noticed a significant and troublesome variation in the clinical management of 40-year-old men with lower back pain.
Butler says doctors would refer patients to participating hospitals, and the health maintenance organization would pay the costs.
Breslau and her colleagues interviewed a random sample of 1,007 adults, ages 21 to 30, who belong to a Detroit-area health maintenance organization. Of 788 "control" participants reporting neither migraines nor severe depression, about 2 percent noted past suicide attempts.

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