Organization ’s - HMO vs. PPO Angela MacLeod‚ Ifeoma Jonathan HCS-413 April 17‚ 2011 Jeffery Dodd Healthcare Organization ’s - HMO vs PPO Introduction A health care system is the organization of people‚ institutions‚ and resources to deliver health care services to meet the health needs of target populations. There are two widely known and used healthcare organizations that deliver insurance to the vast majority of the population‚ Health Maintenance Organizations (HMO) and Preferred
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organizations offer a wide array of benefit designs that include HMO products‚ preferred provider organizations‚ and direct access products that allow patients to self-refer to specialists. (Sekhri‚ 1997) In practice‚ there are three different big categories; HMO‚ POS and PPO. managed care encompasses a wide range of arrangements‚ some of which resemble discounted fee-for-service (e.g.) and others (e.g. some HMOs) using capitation and ‘‘gatekeepers’’ — primary care physicians serving as patients’ initial
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and contrast between an HMO plan and a PPO plan. The HMO plan requires participants to have a primary care physician with the network and the participant does not have the option of visiting a physician outside of the network. They must be referred by the primary care physician to see a medical specialist and the specialist must be within the approved network‚ the plan normally costs less than the PPO plans‚ however the co-pay is significantly high. On the other hand‚ the PPO provides its participants
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co-payments and a minimal dollar amount‚ if any‚ for hospitalization. 2. Older adults who are on limited incomes‚ but are not eligible for Medicaid‚ are able to obtain insurance coverage. 3. Decisions regarding health care are generally made by the HMO‚ and the patient has access to a wide variety of skilled professionals. 4. Much of the paperwork is eliminated. 5. Quality of care issues have been brought to the forefront. Physicians and other health care providers are now more aware of the type
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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
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References: Baker‚ L. (2000). What does HMO market share measure? Examining provider choice restrictions. (Vol.3). Forum for Health Economic & Policy. Bazzoli‚ G.J.; Burns‚ L.R.; Dynan‚ L.; Wholey‚ D.R. (1997). Managed care‚ market stages‚ and integrated delivery systems: Is there a relationship
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While excellent medical care is available in the United States‚ health care economics and the service delivery system present many challenges for the consumer and practitioner alike. This paper addresses four dimensions that are pivotal to the successes and failures of the system: cost‚ efficiency‚ choice and equity. The interplay of these dimensions across the canvas of health care options defines a system in flux‚ policymakers seeking a fair balance‚ and a nation in need of quality‚ affordable
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It is cost effective for both employer and employee‚ as the requirements are more flexible than a HMO plan. PPOs offer more options than HMOs‚ yes‚ there are contingencies that must be followed‚ but it is for less restrictive to have as part of the benefits pack offered to existing and potential employees. It is my understanding that this will be the best option that can
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things you want should help you to determine what is best for you. A HMO is like a club for both patients and providers. Subscribers to an HMO receive medical services from participating physicians‚ clinics and hospitals. PPOs offer choices and access‚ but there is typically a cost associated with that freedom which is quite higher than HMO costs. Point-Of-Service‚ these plans combine characteristics of HMOs and PPOs. You choose a primary care physician who controls all aspects of care‚ including
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something we need to explore. Traditional insurance‚ as back in the day it provided a fee for services rendered or indemnity coverage. This type of coverage gave one the freedom to choose any physician they wanted to see
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