Q: The doctor at the examining table or the HMO
executive in a remote office suite?
In the 1980s, HMOs
gained attention when Congress attached an HMO
provision under the Employee Retirement Income Security Act.
Nearly 30 percent of Medicare HMOs
in California got four or five stars, compared to 11 percent last year.
I fully expected the HMO
policies to favor the superior control of resources and the quality inherent to excellent multispecialty group practices.
Medicare TEFRA-risk HMO
enrollees appear to be, on average, healthier than beneficiaries enrolled in the FFS sector, who appear to be in turn healthier than HMO
Believe it or not, Bill Clinton and leaders of both political parties propose to aggravate the conditions that have provoked the assault on patient privacy--the proliferation of huge computer systems loaded with patient data, and the HMO
habit of reading patient files.
Angered by the problem and the perception that HMOs
are not moving quickly to correct it, AIDS activists have joined the bandwagon to reform managed care organizations.
Compared with HMO
plans nationally (InterStudy, 1996), the HMOs
in the risk sample are older, have larger total enrollment, are less likely to have for-profit tax status, and are more likely to be mixed-model HMOs
Even one of Washington's top HMObashers noted the trend, although he did so in support of his bill that would saddle HMOs
with more regulations.
If an employer offers a health benefits plan to its employ, and includes an HMO
as required by the employer mandate provision, any employer contribution under the plan must "not financially discriminate" against an employee who enrolls in the HMO
For Montclair, the HMO
suggested 40% of full capitation be allocated to outside specialists.
During the 1930s, California-based Kaiser Permanente, now the largest HMO
in the world, began providing pre-paid health care for employees of entrepreneur Henry Kaiser.