The health care organization has both advantages and disadvantages as with the case of other organizations. The fact that people pay less or nothing is indeed the best thing as even the people who cannot afford to get medical attention benefit from it. All patients are able to get medical advice and treated during the start of an illness before cases get complicated. I think providers should be allowed to set their time schedule as they alone know the time they require. Why are patients prohibited from seeking treatment from out of network specialists who may have more experience?
When someone signs up for the health maintenance organization plan he or she will have both advantages and disadvantages. Advantages may include: paying less amount every time they access care and will have full coverage of treatment as long as they remain members of the organization. The disadvantages may include needing a referral before seeing another health care professional. Further, when visiting outside networks they would not be covered by the insurance. Comparing the HMO plans and others like the preferred provider organization, HMO plans suites those people who prefer one primary care physician. What should one consider when signing up with an organization? Should both men and women follow the same laid conditions?
While using the gate keeper system, all parties face advantages and disadvantages. Providers’ advantages include obtaining patients’ history and having the ability to send the patients to the required specialists helps a lot since, patients’ problems get to be solved at the lowest level. This, on the other hand, may result to a disadvantage since more time is wasted trying to find the limited specialists and payers get to pay more to multiple providers. The HMO plan proves to be beneficial to some extent but, would someone risk one’s life when waiting for a specialist to be located yet he or she knows the problem their patient is suffering from? Is it compulsory to see a PCP when he can find treatment elsewhere?
We have been talking about the gate keeping system. Importance of the gatekeepers includes, ensuring patients receive medical care at a cost they can afford. With HMO, one is assured of better healthcare services and despite the small increment of payment it will be worth than paying lots of cash in other organizations. Anything that has an advantage has a disadvantage. Additional healthcare services are increasing and due to technology there is a need for development thus cost may have to increase. Cases that include operations and surgery may turn out to be expensive and hence an additional cost is needed. Should employers take a step and provide HMO to their employees? Would it cost much to ensure your employees health is taken care of? Will there be more of advantages or disadvantages when taking this step?
When visiting the primary care physician (PCP), patient’s conditions are looked into, and the gatekeepers take the go ahead. There might be issues the PCP cannot handle and, therefore, they take the recommended step. However, it is upon them to ensure the patient’s health is safe. There are companies that join hands with these organizations so as to provide better treatment. Its true gate keeping is time saving and economical but should we rely on it? Should patients be included in decision making?
Woods, L. (2007). HMOs prove savvy players in tough world. Westchester County Business Journal, 46(48), 25.
What’s the difference between HMO and PPO plans? Retrieved from http://www.bcbsm.com/index/health-insurance-help/faqs/topics/how-health-insurance- works/difference-between-hmo-ppo.html
Rosenberg & Cameron. (1998). Managed Care Contracting. Retrieved April 2, 2014 from http://www.mcres.com/mcrmcc09.htm
MHN-A Health Net Company (2014) Managed Behavioral Health Program.