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Essay / Research Paper Abstract
A 6 page research paper which provides an overview of the managed health care industry. The writer wades through the alphabet-soup categories of managed health care to provide lucid explanations of the two major types before examining which is best for employers as well as how they impact the quality of medical care which patients receive. Bibliography lists 25 sources.
Page Count:
6 pages (~225 words per page)
File: D0_HMOPPO.doc
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Unformatted sample text from the term paper:
a general overview realizing that many programs these days have features of both of the major forms of managed care. Health maintenance organizations In 1973, the HMO act
was passed by the federal government which outlined the requirements for federal qualifications of HMOs. This included "legal and organizational structures, financial strength requirements, marketing provisions, and health care delivery"
(Rognehaugh 91). Use of HMOs is growing rapidly. As McBridge points out, "In 1993, health maintenance organization (HMO) penetration levels in the United States reached 19.4% up from 17.5% in
1992, with no signs of letting up" (46). Way back when-before managed care-traditional insurance would usually cover 80% of health costs, after the insured individual met a specific deductible. The
insured person got to choose whichever doctor they liked best. HMOs, by contrast, usually work with a network of doctors, hospitals and other medical professionals, and the insured has to
stay within that group (Shelton 34). Usually with an employer footing part of the premium, the insured person usually just has to provide a small co-payment for doctors services or
prescriptions. The theory goes that HMOs, by providing preventative care, keep people healthy and thus keep costs down (Buxbaum 48). HMOs definitely make sense from the point of view of
an employer. Under the HMO system the traditional fee-for-service setup of medicine in which a doctor is paid for each patient visit is completely eliminated (Luciano 111). Instead, a doctor
agrees that he will assume responsibility for a certain specified number of the HMOs patients. For this service, the doctor is paid a monthly flat fee for each patient on
his list whether or not that patient comes in for services (McCue 35). The idea is that this system will encourage doctors to keep their patients well-as if they didnt
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