HMO care and the "Patient Bill of Right's".
People are concerned about rising health care costs. A natural reaction these rising costs, is the gravitation of some toward managed care plans, particularly Health Maintenance Organization (HMO) health plans. One of the characteristics of HMO's that facilitates lower premiums than other forms of traditional health insurance is that main clinical decisions are made not by doctors, but by the HMO's through strict contract guidelines entered into through participating clinicians. Additionally, as opposed to fee-for-service (FFS) companies, patients relying on their HMO's spend 17 percent less time in the hospital regardless of the degree of their illness. This said, patients in Medicare HMOs also spend about 17 percent less time than they would in a traditional setting. It is surprising that, in spite of this fact, Medicare patient risk contracts actually cost Medicare 6 percent more than they would if these same services were done in a fee-for-service setting. (Rice) The lack of savings is not limited to Medicare recipients. Spending on health care in California, which has one of the highest concentrations of HMOs of any state in America, is about 19 percent higher than the national average. There has only been one year since HMOs became so prevalent, 1994, in which employers nationwide saw a drop in their health insurance costs -- and it was an almost imperceptible 1 percent. While keeping claims utilization lower is a positive characteristic of the HMO plans, shareholders of the HMO's stock are more interested, in earnings-per-share calculations, which most clinicians argue is the primary concern of HMO's rather than patient care. It is a passionate and complex argument.
As previously intimated, the HMO's rather than the physician become the patient primary decision maker. In other words, the medical decision making process is subject to procedures established by the HMO's.
