Health Maintenance Organizations in the U.S.

Paper Summary:

The term "HMO" was developed in the early 1970s as part of a Nixon Administration strategy to promote the growth of prepaid plans as a way of improving the capacity and efficiency of the nation's health system. The 1980s were a time of great development. In response to the access of high quality health care at affordable rates, HMO numbers increased, as did the number or members enrolled. The paper shows that today, however, consumers are starting to question the quality of health care that they are receiving. Therefore, HMOs are beginning to lose their popularity and fight an ongoing battle in the high cost of health care.

From the Paper:

"There is also something of a conflict of interest in the way NCQA is financed. About half of its budget comes from accreditation fees, which may create an incentive against setting standards too high. Critics of NCQA and HEDIS say someone who is outside of the industry should perform accreditation and quality review. Bruce Vladeck, former head of the Health Care Financing Administration, suggested that for HEDIS to be a true measure of acceptable HMO practices some indicators should be on a "pass-fail" basis -- certain practices should be flatly off limits. However, according to NCQA president Margaret O'Kane, only one practice is flatly banned: giving utilization reviewers explicit financial rewards for minimizing treatments or admissions."

More papers on Health Maintenance Organizations in the U.S.:

• Research Paper # 51921 : "Health Care Politics and Policy in the U.S.A.: A New Systems Approach"
• Research Paper # 46378 : "The Importance of Quality Assurance in Managed Care"
• Research Paper # 26090 : "HMOs and Poor and Low-Income Communities"

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