HMO Regulation Essay -- essays research papers

HMO Regulation health Maintenance Organizations, or HMOs, ar a very primary(prenominal) part of the Ameri underside health burster system. Also referred to as managed grapple programs, HMOs are combinations of doctors and insurance companies that are formed into one brass instrument. This organization provides intercession to its members at fixed cost and decides on what interference, if any, will be prone based on the patients or doctors current health plan. Sometimes, no word is given at all. HMOs main concerns are to realise costs and purportedly provide the best possible treatment to their patients. exclusively it trancems to the naked heart that instead their main goal is to get more mass enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMOs, profit comes first- non patients lives. HMOs are groups of doctors engage by insurance companies and are usually controlled or regulated by the hospitals who facilitate them. The majority of this limitation is due to pressure from within the organization or government pressure. The government influences hospitals into turn downing treatment in order to undercut federal costs. These government actions generally result in a decree of private employee health care claims, and in turn certain businesses can no longer afford to provide health insurance for their employees. Consequently, nigh 50 to 60 million people go without insurance for at least one month each year. Many HMOs constantly evaluate their services to "ensure" the best care and coverage. But in many cases, what is happening is the exact opposite.HMOs can and do claim their business quite ruthlessly. Patients are continuously unable to fulfil the unavoidable treatment due to the insufficient HMO coverage. Many HMOs actually feed more money if their doctors see or treat fewer patients. fit in to the Associated Press, Consumers who have been denied a treatment that the HMO sa ys is not covered, or who unknowingly fail to follow HMO guidelines in seeking treatment and are at that placefore denied reimbursement, will continue to have little recourse. (2) Many people must drive for hours, generally sick or injured, simply to receive treatment from a doctor that will be covered by their HMO. Another downfall to HMO coverage is selective-contracting. This is a process where hospitals deny treatment to patients because their... ...ts to cover their mistakes. This is the exact opposite of what the country needs. Why should costs go up because of denied treatment? The big concern is whether or not government really understands the great difficulty in trying to control HMOs and other health care programs without a nationalized program. Since there are some 6 million people using Medicare in HMOs something needs to be done to ensure these patients the treatment that they need.     In conclusion, there relieve needs to be a jackpot of work done to health care in the United States. other nations provide universal health care to their citizens, but this would cause dilemmas in balancing two often conflicting policy goals providing the public with frank access to needed pharmaceuticals while controlling the costs. Universal health care probably would not work in the U.S. because our nation is so assorted and our economy is so complex. The system we have now obviously has its problems, and there is a lot of rom for improvement. HMOs will still create problems for people and their medical bills, but they definitely should be monitored to see that their patients are receiving just treatment.