Useful Resources
HMOs: Health Care Cost Containment
December 16, 2008
Health Maintenance Organizations (HMOs) are a form of insurance-financed managed care. In a managed care system, a health insurance plan pays a closed network of doctors and hospitals an annual rate for each enrollee regardless of how much health care that enrollee uses. If a group of enrollees uses less health care than the insurance company paid for in advance, the doctors and hospitals keep the difference as a bonus. This system is called "capitation." A primary care doctor typically acts as a gatekeeper for an HMO enrollee and refers him to a closed network of specialists when necessary. Theoretically, managed care should keep health care costs down by providing doctors with incentives to keep their patients healthy and avoid expensive hospital care. HMOs became very popular in the late 1980s and throughout the 1990s as a cost-containment method, but in recent years, patients began to revolt against them. Some patients didn't like the closed provider network, and others questioned their physician's and insurance companies' motives when they were denied care. Almost 64.5 million people belonged to an HMO as of July 2008, according to StateHealthFacts.org, a website sponsored by the Henry J. Kaiser Family Foundation. This is their most recent estimate as of August 2009. Updated February 2010
Resource Links
Blogs
The prestigious health policy journal publishes a regular blog that covers managed care and other policy and economic trends
Joe Paduda, an industry veteran, discusses developments in HMOs and health insurance in general in his daily blog.
Guidance for Consumers
This site includes a checklist to help consumers overturn managed care treatment denials
The foundation's website includes a checklist to help consumers "diagnose their health coverage" and choose the best plan
Online guide to help consumers handle disputes with their health plans
This state agency explains HMOs and rates them for consumers
Advocacy
A national nonprofit organization based in Washington D.C. that calls itself "the voice for health care consumers." Families USA advocates to strengthen health care coverage for families and individuals.
Public Policy
This federal government site includes statistics and reports on HMO usage in the public programs
This foundation's website includes many research papers on the impacts of managed Medi-Cal
This California state agency publishes statistics about health plans, enforces regulations, and advocates for patients
Statistics, Trends and Research
This Kaiser Family Foundation-operated site includes estimates of private and public HMO enrollment by state
The leading health policy journal publishes many studies looking at various aspects of managed care
This nonpartisan think tank analyzes various aspects of the health care market, including insurance products and HMOs
Advocacy, Statistics, Trends and Research
This arm of the California government compiles an annual HMO report card ranking the state's health plans. It also keeps statistics about health plans, and enrollment by company, plan type, age, gender, and more.
Understanding HMOs
Good background on the rise of managed care and subsequent consumer backlash
This site's HMO Guide provides a good explanation of how managed care works. The Institute is a health care advisory group to the governor of North Carolina.
Part of the National Institutes of Health, Medline Plus provides an overview of managed care, as well as links to other useful consumer and research sites
