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 ?
The 'article four' rule aims to control the numbers and concentration of HMOs in the area, given it comprises mainly family homes.
In a statement issued on Tuesday, the IC said that the issuance of underwriting guidelines for HMOs in line with individuals with HIV are in line with Republic Act (RA) 11166 or the Philippine HIV and AIDS Policy Act.
It is likely that no other authority in the country has such highquality data on HMOs, and I would like to place on record my thanks to Prof Smith and Andreas for their work.
However, the insurance chief reiterated there is a need for more regulations concerning different aspects of the operations of HMOs in the country.
Early this year, Funa said the regulator was pushing for stricter regulation of HMOs through a law ensuring that consumers would be better protected.
Following assessment, 48% of HMOs were found to contain Category 1 hazards, the most serious, compared to 38% of non-HMOs.
Rural hospitals, which account for 15 percent of total hospital spending, are excluded because HMO variables are measured at the MSA level.
Also, "aspects of consumerism like engagement models, cost and quality transparency, and choice and convenience mechanisms, are being layered onto what we traditionally thought of as products like PPOs [preferred provider organizations] and HMOs," said Tom Richards, senior vice president of product for Cigna Healthcare.
If HMO plans are less expensive because they are designed and managed differently, there are efficiency gains due to the more efficient use of health care resources and consumer welfare gains due to greater product selection.
In calendar year 2000, two-thirds of Medicare enrollees lived in a geographic area served by at least one risk health maintenance organization (HMO) (Figure 1).
Rising health care costs may spark a resurgence of the HMO among consumers--especially those with low incomes, the Center for Studying Health System Change reports.