Health Care System Evolution Paper

This paper will discuss how HMOs have influenced current health care systems. HMOs have been able to reduce health care cost in many ways and have also faced many difficulties along the way. Many Americans years ago did not have health coverage and we are still seeing this today because of the cost of these plans. HMOs or Health Maintenance Organizations are health care plans that reduce health care cost. Members of an HMO are usually required to make a co-payment when seeing a physician.

A lot of time members have a deductible they will have to pay before they are able to see their physician too. These are just some of the ways HMOs try to keep health care cost down. There are some 75 million Americans today covered under HMO plans. HMOs play a very strong role in determining how health care is delivered and how health care dollars are distributed. HMO enrollment has led to substantial reductions in hospital cost (The Rise of HMOs, n. d. ). HMOs deliver health care to its members by networks.

The networks are hospitals, groups of doctors and other health care providers which have agreed to serve members of a particular HMO (How do HMOs work, 2009). Early HMOs and other similar institutions developed in the 1930s. The movement grew slowly in its first few decades and the majority of HMO enrollees belonged to the Kaiser System (The Rise of HMOs, n. d. ). The American Medical Association (AMA) leaders were opposed to this organization, AMA associates were afraid that HMOs would lead to socialized medicine (The Rise of HMOs, n. d. ).

Kaiser offered prepaid health care to his employees, and with the determination of Kaiser and a handful of physicians, the HMO movement somehow survived. HMOs were put into place to provide affordable quality care for the American people. Unfortunately, many Americans still do not have access to quality care because it is not affordable to many people. Uninsured Americans, if they do choose to go to the doctor they have to pay high out of pocket expenses or the just simply do not go to the doctor. This is a bad situation either way you look at it.

Big HMO giants and doctors have made billions of dollars of the American people. Many people struggle just to pay their premiums and then there are those who simply cannot afford to have health insurance all together. HMOs have succeeded at enrolling a large amount of the American people, and overall quality of care for HMO enrollees is good. But HMO actions have created conflict with providers, consumers and government policy makers. There are many questions about the efficiency of HMOs abound (The Rise of HMOs, n. d. ).

President Nixon signed a bill promoting widespread HMOs with the goal of improving care with preventive measures. While in the beginning HMOs were meant to improve quality and now the goals are to reduce cost (Mamdani, 2001). In the 1960s is when the growth really began, and in the 1970s there were 37 HMOs in 14 states with an enrollment of three million people (The Rise of HMO, n. d. ). For profit businesses and the stock market began to play a big role in the expansion of HMOs in the late seventies. Organizations such as Blue Cross Blue Shield and Prudential teamed up with some of the new HMOs.

With all of these factors in place the HMO movement continued to grow (The Rise of HMO, n. d. ). In the late 1980s some of the HMOs were not run properly which caused 76 HMOs to shut down due to bad management. Enrollment continued to increase from 39 million in 1992 to 79 million in 1998. This left many organizations feeling like they had no other choice but to convert to the HMO insurance (The Rise of HMO, n. d. ). There are many plans that members are able to choose from and many times members want to be able to decide what doctor’s they want to see.

HMOs offer plans that give members more choices. A Point-of-Service (POS) plan and a Preferred Provider Organization (PPO) are two examples of these insurance plans. By using the POS or PPO plans it may cost the consumer more than it would by using a traditional HMO (What is an HMO? , 2009). With a POS plan, members can use doctors who are within the network or those who are not in order to receive their care. If member do choose doctors outside their networks they will have to pay more to have those services performed. With the POS plan members must have a primary care physician.

With a PPO plan members have more options over who they can see. Members do not need a primary care physician with this type of plan (What is an HMO? 2009). HMOs have been running strong for years but to remain viable they are going to have to make some changes. Considerable evidence points to physician and consumer dissatisfaction with HMO’s. Consumers are not satisfied with primary care physicians as gatekeepers, limited provider choice, physician profiling, requirement of prior approval and constraints on covered treatments (Fang, Liu, & Rizzo, 2009).

Studies have shown a slight decline of the insured population covered by HMOs. In 2000-2001, 55 percent of the insured population was covered and in 2003 it dropped to 51 percent (Fang, Liu, & Rizzo, 2009). President Obama signed into law a new health care plan that will help many Americans. With the way things were going, many people were not able to carry health insurance and those companies that were carrying insurance had to drop coverage for many of their employees. Many doctors and big HMO companies have made a killing over the years, and want to keep doing so.

That is why many did not want to see this new health care reform signed into law. The health reform will make health care more affordable, make health insurers more accountable, expand health coverage to all Americans, and make the system sustainable, stabilizing family budgets, the Federal budget, and the economy (Health Care, n. d. ). The health care reform will help the middle class and small business owners. It will help 32 million Americans afford health care who do not get it today.

It will prevent insurance industry abuses and denial of care (Health Care, n. d. ). HMOs have been able to cut cost in many areas but have still had many difficulties over the years. Many Americans years ago and today are still not able to have quality access to health care. The HMO companies and doctors have made so much money over the years. Hopefully with the new health care reform those who are not insured today will have a chance to obtain coverage. This will make a way for so many to have the coverage that we all deserve.

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