Health Maintenance Organization

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Health Maintenance Organization

Commonly called an HMO. A nonprofit organization that offers health insurance to a group of persons and charges members of the group the same monthly premium. Most HMOs require policyholders to have a primary physician who provides referrals for specialists and other medical services. Without these referrals, medical care generally will not be covered. This fact has made HMOs somewhat controversial. However, they generally operate at a lower out-of-pocket cost to consumers. They trace their origins to the early 20th century, but became more popular after the Health Maintenance Organization Act of 1973.
References in periodicals archive ?
As the HMO continues to evolve, Pisano said, it will likely borrow features from some of the newer models that emerge.
I'm in the exploratory, creative phases of a potential clinical and business model, but any health reform strategy is going to be far more complex than the HMO approach, which left too much to chance.
There are several reasons why Ellwood's hope that "market forces" could protect patients from HMO abuse was doomed.
Savvy Medicaid patients can get top-quality care without having to clear the bureaucratic hurdles erected by some HMOs.
Five of the 15 risk sample HMOs and 3 of the 11 commercial sample HMOs identified HCFA's access standards (which require that enrollees have access to primary and specialty care within certain distance or travel times) as Federal requirements that are more difficult for the HMO to meet in rural areas.
1,252,000 Statement of income Year ended Decomber 31, 1994 Revenues Net patient service revenue-non-hmo 1,250,000 HMO capitation receipts 2,600,000
Most of the well-established HMOs and managed care plans have a sizable number of participants--albeit white--with large, multi-disciplined practices.
And HMOs managed to push the number of hospital days for Medicare members 1 per cent lower than in 1988.
Supreme Court decision barring patients from suing their HMOs in state court over denied benefits is seen as a significant victory for health insurers.
That provides for a pretty simple equation: If people are paying the health maintenance organizations more, and the HMOs are paying the doctors and hospitals less, the HMOs must be making out like bandits.
On January 1, 1999, more than 400,000 Medicare recipients lost their HMO coverage.