The health management organization, or HMO, is a viable medical plan that serves as the healthcare coverage for many people. Over the years, this form of medical insurance has been alternatively praised and condemned among patients and health care professionals alike. If you are considering the possibility of using HMO care as your health plan of choice, here are some of the benefits and drawbacks commonly observed by supporters and detractors.
There are a number of advantages associated with HMO care. One has to do with cost. In terms of the monthly premium, health insurance through an HMO simply costs less. This is true whether the individual pays the entire premium or an employer picks up all or part of the monthly charge. In addition, many plans do not have any type of deductible or require a co-payment from the member. From this perspective, this type of care is immediately attractive to any individual or business where there is only a limited budget for medical coverage.
HMO care also carries the advantage of establishing a network of health care providers that are readily available to each member of the organization. Most health maintenance organizations require that a new member choose or be assigned a primary care physician from their roster of local medical doctors. For people who have never had one general practitioner that they see at least annually, this requirement is often viewed as a positive situation.
With this type of care, the primary physician functions as the gatekeeper for each member in his or her client group. When there is a need to refer a patient to a specialist, the primary doctor makes all the arrangements, scheduling the appointments with a specialist who is also associated with the HMO. Not only is this convenient for the patient, but it also helps to ensure the services of the specialist are covered under the plan, minimizing the potential for out of pocket expenses for the HMO member.
While there are many good points to HMO care, there are also a few concerns that have emerged over the years. One common complaint is that new members often must abandon their current primary care physician in favor of a doctor associated with the HMO. This can be troubling for anyone who has a great deal of confidence and trust in his or her current physician.
A similar concern has to do with the selection of a primary care physician. Some HMO care plans allow the member to choose a physician from a list. Others simply assign the member to an in network doctor. Switching from one HMO physician to another on the same network is not always an easy task. The result is that some HMO members feel stuck with a doctor they don’t particularly like or trust.
Seeing a specialist is out of the question without a referral in most HMO programs. Even if the specialist is in the local HMO network, most plans require that the primary care physician provide a referral before the appointment can be scheduled. This can be an issue, since the very nature of an HMO often creates a situation where the primary doctors are expected to keep medical costs low. If the doctor is more interested in the bottom line and less in the welfare of the patient, obtaining a referral can be a hard and sometimes impossible task.
Should your assigned primary care physician decide to leave the network, the HMO program will reassign you to another physician, often before you know that your doctor is no longer available. This makes it necessary to essentially start over with another doctor and attempt to build a working physician/patient relationship all over again. If there is a frequent turnover in a given HMO, members may find themselves going through this process two or more times each calendar year.
Former members of HMO care programs have also noted that many primary care physicians are inundated with huge numbers of assigned patients. This creates a situation where the doctor is bound by a contract to treat the patients as quickly as possible. As a result, patients are often hurried through the process, making it much easier to overlook important signs or symptoms. This opens the door for a serious ailment that is just forming to go unnoticed until it is apparent enough to require extensive treatment.
While there are some very good points to HMO care plans, the quality of plans vary from one provider to the next. Before committing to any HMO, make sure you get information on the size of the local network, what options the members will have in choosing a primary care physician, and the rate of turnaround within the local network. This will help you to have a better idea of whether you are likely to encounter more benefits and less disadvantages if you choose to obtain this type of medical care coverage.
