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In message <[log in to unmask]> Richard Lucas writes: >Greetings from Poland. > >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 ? > For those interested in the labyrinthine world of US managed care, I very strongly recommend a look at the Physicians for a National Health Programme page <http://www.biostat.wisc.edu/pnhp>. On the sub-page <terms.htm> attached to this you will find a comprehensive discussion paper defining not just HMOs but all the other entities doctors there have to deal with (a spell of duty over there might temper some of the anti-NHS moaning on this list :-) FWIW, the HMO is really just a private mini-NHS, a payer organization that contracts with individual health provider bodies to deliver "good-enough" care to a defined population. >From the patients' point of view there are three main drawbacks: first that the level of care provided is not very well defined beforehand (as in the NHS!) and so you might find yourself refused treatment when it's too late; second, that your HMO is usually chosen by your employer and not by yourself; and thirdly, HMOs, like other insurers, have so far been at liberty to refuse coverage to people with 'pre-existing conditions'. Since you are booted out of your health plan when you change jobs (after a period of grace), this means a change of employer after, say, a heart attack, might well mean a permanent end to your health coverage (until you reach Medicare age). But the new health reform bill about to be signed by Clinton will change this, at long last. >From the doctors' point of view, the advent of managed care organizations such as HMOs means an end to the gravy train of guaranteed fee-for-service payments from the patients' insurers, regardless of the medical necessity for the treatment given. It also means that doctors dealing with patients in an HMO may need to get administrative pre-approval for just about every prescription, procedure or referral they think is necessary - because if the HMO disagrees, it won't pay. -- Pete Mitchell, Editor, e-Med News - an international newsletter on electronic data in medical applications ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ details and free headline news: http://www.pjbpubs.co.uk/a/emedhome.html or mail for info to : [log in to unmask] ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%