HMO Regulation Essay

1431 Words6 Pages
HMO Regulation Health Maintenance Organizations, or HMO's, are a very important part of the American health care system. They involve elements such as beneficial health care programs like Medicare for seniors and Medicaid for the poor. HMO's are sometimes referred to as managed care programs, which involves participation through clinics, physicians and insurance companies. Other essential parts of HMO's include prescription drug plans, such as distribution and cost, and they are also important for information needed by emergency room residents in cases of emergencies. Although HMO's are not always seen as positive and helpful institutions, they are definitely important when it comes to medical care. Most of the criticism comes…show more content…
They provide the best possible treatment to their patients to get more people enrolled and to maintain current premiums paid by consumers using their HMO's. Most HMO's are groups of doctors hired by insurance companies and are controlled or regulated by the hospitals who facilitate them. They also limit what kind of care they receive. Most pressure comes from the government and its ability to influence hospitals to deny treatment. These regulations are expensive and result in revision of private employee health care claims. This type of behavior results in increased spending by the public and more people become uninsured, approximately 50 to 60 million people go without insurance for at least one month each year. Particular HMO's face many additional problems due to attempted government control through regulations. One such institution is the United Health Group in New York. The United Health Group said, "that it returns decision-making power over patient care to physicians on issues like admitting health plan members to hospitals or providing other treatments." [4] This kind of decision is made to eliminate frustrating features of most doctors' work: like getting insurance companies to approve medical decisions that the doctors think they should make. This is a problem because most hospitals are influenced by government officials and make their decisions
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