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Question and some thoughts about HMO's (health maintenance organizations)

post #1 of 8
12/27/09 at 10:01am
Thread Starter 
I'm guessing Obamacare can reduce the relevance of this thread, but I was just curious to hear from others.

The first time I heard "HMO" I was very young and didn't care.

It wasn't til much later I learned "HMO" stood for

Health Maintenance Organization

Interesting name in my opinion. In analyzing (or overanalyzing?) the word "maintenance", I simply must ask: Was the original intent to service people who were already healthy and give them preventive care? If that was the original intent, I'm not sure it worked out so well. Or was it simply a name? Do they even exist anymore? I remember the mere mention of those 3 letters H-M-O could get lots of folks hot and bothered years ago (maybe still?). Even in the movies, in As Good As It Gets, the waitress/mom expressed disgust with HMO's because of the way they treated her son.
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post #2 of 8
12/27/09 at 10:59am
A lot of HMO's were corporations that provided care by capitation. That means they received a certain amount of money per member, no matter how much actual care they provided. The theory was that they would be motivated to take care of the small stuff immediately so that it wouldn't get worse, and to provide care that improved overall health, such as nutritional care, exercise, etc. In addition, they charged a very small co-pay. Enough to help defray costs and discourage running to the doctor for every sniffle, but not enough to discourage people from using the doctor when they needed it.

This was "managed care," much as what most national systems employ. It can work very well, but you don't often have your own personal doctor: You see whatever doctor is available next, and you can go to whatever office is closest to you.

True HMO's are very rare today; mostly, groups of doctors agree to act as an HMO for an insurance company, such as AETNA.
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post #3 of 8
12/27/09 at 11:06am
I think the new trend is HRAs and HSAs. That's what the insurance companies seem to be pushing lately. The only HMOs I've seen offerered are with dental.
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post #4 of 8
12/27/09 at 1:18pm
HMO's were back when I actually worked for good Corporations and had great insurance. This was back in the mid 80's and if I can remember correctly the prescriptions were 3.00 and dr's visits were something like 5.00. I do know that in 1987, and 1989 I had to have 2 major operations and they were all paid for in full by my insurance. Those days are over!!!!!!

When I was in my early 20's I remember being really sick and I didn't have the money and insurance to cover it and the hospital would work with you on your income level. But that was back in the late 70's early 80's. This is unheard of anymore.

I don't know what happened but it sure is a mess now.
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post #5 of 8
12/27/09 at 3:28pm
Quote:
Originally Posted by abbycats View Post
When I was in my early 20's I remember being really sick and I didn't have the money and insurance to cover it and the hospital would work with you on your income level. But that was back in the late 70's early 80's. This is unheard of anymore.
I had a similar situation as recently as 2004, when I was in college (I was taking classes but the "automatic" in my school's "automatic student insurance" meant "automatic except in summer") when I landed in the emergency room for an ankle so severely sprained that it would have healed faster if I'd gone the distance and broken it. I made some pretty low payments (what I could afford working for the campus chow hall...in fact they set the amount so low that I managed to pay it off early) for a few months and they wrote off the bulk of it (over $800). Since emergency rooms have to take care of whoever shows up, hospitals have access to government funds and sometimes also private charitable foundation funds.

Having had both at different times, my understanding of the difference between HMOs and other insurance is that with an HMO you have to go through your regular doctor to have specialist care covered on insurance. Some also let women have a gynecologist to go to without a referral. Usually this results in lower premiums because that keeps the hypochondriacs from going to the expensive specialists. The tradeoff is an extra copay, having to wait to get two appointments instead of just one, and a bit less control over one's care.
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post #6 of 8
12/31/09 at 10:13pm
HMO means less choice - to me, anyway.
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post #7 of 8
1/5/10 at 5:21pm
One big downfall of the HMO idea is that the theory is based on a long-term relationship. Most HMO's figured out that as like as not, their patients would not be with them for more than a few years, since Americans are changing jobs a lot more now than they did 60 years ago. So, it became a game to keep you just happy enough and just healthy enough not to require major care until you had moved on to the next HMO.
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post #8 of 8
1/6/10 at 12:21pm
Thread Starter 
Thank you guys. As the saying goes: Change is a constant
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