Health Maintenance Organizations (HMOs) and prospective payment systems vary wid

Question

Health Maintenance Organizations (HMOs) and prospective payment systems vary widely in quality and costs and employ a variety of methods to control costs. Discuss the financial pros ad cons of HMOs and include a clear discussion of how the HMO impacts quality of health care. Prepare a table which compares and contrasts any TWO existing HMO plans. You may want to select HMO’s from different states to fully explore the differences. Finally, use the information you found to create a strategy for explaining the programs to a patient and their family.                                

Explanation / Answer

Pros of HMOs:

1) Members have flexibility to go for both in and out of network providers.

2) For in network service discount is provided.

Cons of HMOs:

1) Out of network service need to be paid by members and later they can claim for that with HMOs.

2) For out service less coverage and discount is given.

HMOs impacts quality of healthcare by covering broader range of doctors and physicians. They even provide discount for referral fees of doctors i.e small co-payments.

Comparision and contrast of Two HMOs plans:

In order to explain the benefits of HMO to patients following points can be discussed:

1) As it cover a large number of physician with discount in the co-payment for their in-service, patient will receive high quality service.

2) Emergency cases is also covered for both in and out service.

3) No filing of claim is required for in-service visits.

Staff Model Group Model Physician are under HMOs Physician are not direct employ of HMOs It is an example of closed model HMOs It is an example of captive model HMOs

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