In message <[log in to unmask]> Richard Lucas wrote:
> I am interested in HMOs, which I understand to be American commercial
> health care providers which feature the integration of private health
> insurance and provision of care. Does anyone on GP-UK have any
> knowledge, experience, opinions or suggestions for further reading on
> the questions:
>
> 1. Are HMOs a good thing ?
> 2. Are HMOs an effective way of delivering health care to patients ?
> 3. In what ways are UK fundholding GPs similar to the US's HMOs ?
>
> I recently heard the opinion that HMOs are virtually the only bright
> star in the dim galaxy of American health economics, but it was not
> from a doctor.
If you are interested in an academic appraisal of the subject I would
recommend pointing your "search engine" or library scan at anything by
Prof. Harold S Luft from the Institute of Health Policy Studies,
Univ. of California, San Francisco.
I don't have the reference to hand but ISTR he published a definitive
review article in JAMA within the last year or two.
With regard to the similarities with UK fundholding Clive Smee (chief
economic adviser at the DoH) recently observed that:
"American economists identify four underlying reasons why large
physician or medical groups have advantages over small independent
practices:
1. Economies of scale
2. Ability to spread the financial risk of capitation payments
3. Reduction in transaction costs of negotiating, monitoring and
enforcing agreements
4. Creation of an organisational context for continuous process
innovation. "
The British and American models appear to be converging on a
purchaser/provider split which is based on a population considerably
larger than an individual practice. In the UK the population will
probably be a geographically defined district while in the USA it will
be a managed care organisation such as an HMO or PPO (there are a
variety of models). The population base will be 100 - 500,000.
Hope this helps.
Trims.
________________________________________________________________________
Dr Ian Trimble email: [log in to unmask]
Sherwood Health Centre
Elmswood Gardens Tel: +44 115 962 4516
Nottingham NG5 4AD Fax: +44 115 985 7899
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