Hmo Advantages And Disadvantages

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A health maintenance organization (HMO) is a health insurance provider with an organization of hired healthcare providers and facilities. Subscribers pay a fee for access to services within the HMO's network of providers. An HMO contacts its network of clinical facilities, specialists, and primary care physicians. The HMO reach an agreement to pay these health care providers a set amount of payment (capitation) for a variety of services the health care providers supply to the HMO’s subscribers. In return for a monthly fee (premium), subscribers are permitted admission to health care providers inside the network at no additional cost. There are advantages and disadvantages to every health insurance policy. In my opinion, HMOs can be seen in …show more content…
An advantage is HMOs lower the risk of patients being over treated. In my opinion, this can be a good and bad thing. The patient does not know this, but maybe the test is necessary to diagnose the patient, but the provider does not want to perform it because the provider does not want to pay out of pocket for it. It can be a good thing because some providers like to run every test in the office to make as much money as possible from the patient and HMOs limit this. Another advantage is HMOs helps lower general costs and are usually the cheapest and preferred method of insurance and provide an enormous network of physicians in most areas. For example, when an HMO contracts with a network, the policyholders get a special advantage which is keeping health-care costs under control. An HMO tells the health-care providers in its network what they can and cannot charge. This helps to protect the subscriber’s pocketbook. A disadvantage is that the subscriber is limited to only the providers in network and if the subscriber decides to go out of network it will be paid mostly out of pocket. Another disadvantage is that a co-payment must be paid with every visit to the provider which can become expensive if the patient has any chronic conditions. Additionally, if this chronic conditions needs to be handled by a specialist, a referral must be received through the primary care physician. The list of disadvantages can continue. In my opinion, I would not subscribe with an HMO. I understand that it is very cost effective, but it brings down the quality of health care, and I may not get the best medical
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