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HMO development in an academic medical center: The rise and fall of a prepaid health program in New York City

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Abstract

Through a documented case study the authors identify the critical factors that impede the introduction of prepaid medical care as part of education and practice within a prestigious and well established academic medical center. The inherent conflicts between individual fee-for-service practice and population-based prepaid practice and the resistance to innovations in medical care organization as they surfaced in that center, are presented. The need for a clear understanding of the complexities of HMO development and of an appreciation for the importance of a planning process in which all interested parties are involved, is emphasized. A clear commitment by policy makers, administrators and providers is highlighted as fundamental for the implementation of a system where practitioners are motivated to assume responsibility for the comprehensive care of a defined population that prepays for their services. The rewards as well as the difficulties for institutionalizing commitment to this form of health care delivery and impacting on medical education are discussed.

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References

  1. Flexner, A.Universities—American, English, German, Oxford University Press, 1930.

  2. Falk, I.S. Medical Care in the U.S.A.—1932–1972: Problems, Proposals and Programs from the Committee on the Costs of Medical Care to the Committee for National Health Insurance.Milbank Mem. Fund Q 51:1–32, 1973.

    Google Scholar 

  3. Starr, P.The Social Transformation of American Medicine. New York: Basic Books, 1982.

    Google Scholar 

  4. Luft, H.S.Health Maintenance Organizations: Dimensions of Performance. New York: John Wiley and Sons, 1981.

    Google Scholar 

  5. GHAA Research and Analysis Department,GHAA National Directory of HMO's: 1990.

  6. Somers, A.R.The Kaiser Permanente Medical Care Program—A Symposium. Oakland, California: The Commonwealth Fund, New York, New York, 1971.

    Google Scholar 

  7. Infeld, M.D.Primary Care Education in HMO's: Curriculum Content, Evaluation and Costs. Final Report (PB-261-976), Springfield, Virginia: National Technical Information Service, 1976.

    Google Scholar 

  8. Association of American Medical Colleges,Medical Practice Plans at U.S. Medical Schools. Washington, D.C.: Dept. of Health, Education & Welfare, H.R.A., 1977.

    Google Scholar 

  9. Hudson, J.I., Nevins, M.M., eds.Health Maintenance Organizations and Academic Medical Centers: Proceedings of a National Conference. Menlo Park, California: The Henry J. Kaiser Family Foundation, 1981.

    Google Scholar 

  10. Kalinowski, R.H., Ackerman, S.J. eds. HMO Program Development in the Academic Medical Center.J. Med. Edu. 48:4, 2, 1973.

  11. Moore, G.T. History of the Harvard Community Health Plan. In Hudson, J.I., Nevins, M.M., eds.Health Maintenance Organizations and Academic Medical Centers: Proceedings of a National Conference. Menlo Park, California: The Henry J. Kaiser Family Foundation, 1981. Pp. 190–209.

    Google Scholar 

  12. Huntley, R.R. The Georgetown University Community Health Plan. In Hudson, J.I., Nevins, M.M., eds.Health Maintenance Organizations and Academic Medical Centers: Proceedings of a National Conference. Menlo Park, California: The Henry J. Kaiser Family Foundation, 1981, Pp. 173–189.

    Google Scholar 

  13. Perkoff, G.T.,Changing Health Care: Perspectives From a New Medical Care Setting. Ann Arbor, Michigan: Health Administration Press, 1979.

    Google Scholar 

  14. Popper, H. The Mount Sinai Concept.Clinical Research 13:500–504, 1965.

    Google Scholar 

  15. Popper, H., Koffler, D. The Goal,J. Mt. Sinai Hosp. 34:401–407, 1967.

    Google Scholar 

  16. Forty-six grants for HMO planning and development totaling $3.2 million were awarded by HEW in the first half of 1972.Hospital Week, February 4, 1972.

  17. Comptroller General of the United States. Report to the Congress.Effectivenes of Grant Programs Aimed at Developing HMO's and Community Health Networks. DHEW: 64–66. Washington, D.C. 1975.

  18. Bosch, S.J., Fischer, E., Deuschle, K.W. A Framework for Participation: The Contribution of a Medical School to Local Health Planning.Mt. Sinai J. Med. 46:552–555, 1979.

    Google Scholar 

  19. Merino, R., Rose, D., Bosch, S.J. A Medical School's Involvement in the Development of a Community-Based Health Center.J. Comm. Hlth. 8:130–140, 1982.

    Google Scholar 

  20. Bosch, S.J., Merino, R., Daniels, M.S., Fischer, E., Rosenthal, M. A Proposed Network to Improve Access to High-Quality Health Care for Medicaid-Eligible Families.J. Comm. Hlth. 4:301–311, 1979.

    Google Scholar 

  21. Bosch, S.J., Fischer, E. The Role and Functions Assumed by a Department of Community Medicine in Planning a Group Practice.Hlth. Pol. Educ. 2:167–176, 1981.

    Google Scholar 

  22. Bosch, S.J., Merino, R., Rose, D.N., Julius, H. Community Participation in New York City: Success or Failure? A Case Study.Am. J. Prev. Med. 2, 4:198–204, 1986.

    Google Scholar 

  23. Fischer, E., Bernstein, R., Holstein, E.C., Josi-Langer C., Dolan, E., Bosch, S.J. An Experiment to Test the Feasibility of Integrating Occupational Health Services into an HMO.J. Pub. Hlth. Pol. 2:261–273, 1981.

    Google Scholar 

  24. Bernstein, R.H., Silver, A.L., Wertheim, R.I., Bosch, S.J. A Capitation-Based Prospective Reimbursement Mechanism for Linking Academic Medical Centers with Health Maintenance Organizations.Health Care Strategic Mgmt., December 1983.

  25. Baehr, G. “A Report of the First Ten Years Health Insurance Plan of Greater New York.” 1957. Pp. 1.

  26. The Dr. George Baehr Professor of Medicine Chair.

  27. Borst, D., Bosch, S.J. Report to the President of the Medical Center and the President's Advisory Group. February 2, 1985.

  28. Ernst & Whinney. Letter of understanding with Federation of Jewish Philanthropies Hospitals regarding the development of an alternative delivery system strategy. July 19, 1985.

  29. Freudenheim, M. “HMO Growth Displays Vigor.”New York Times, New York City, April 16, 1985.

  30. Maxicare Health Plans Inc. News Release: Maxicare and Major Teaching Hospitals to Offer HMO Program in New York. New York, N.Y., November 7, 1985.

  31. Glenn, J.F. Memo to chairmen of clinical departments, Mount Sinai Medical Center announcing the formation of an HMO Implementation Task Force. November 6, 1985.

  32. Sullivan, R. “Hospitals Move to Prepaid Care for New Yorkers.”New York Times, New York City, December 2, 1985.

  33. Glenn, J.F. Memo to all chairmen at Mount Sinai Medical Center, April 3, 1986.

  34. Gelernt, I.M., Jaffin H. Memo to the attending staff, Mount Sinai Medical Center, March 18, 1986.

  35. Hardie, A.E. “Mount Sinai Chief Executive Announces His Resignation.”New York Times. December 1, 1986.

  36. Hansen, H.R. Group Health Plans: A Twenty Year Legal Review.Minnesota Law Review; 530 ff., 1958.

  37. Roemer, M.I. Medical Ethics and Education for Social Responsibility.Yale J. of Biol. & Med. 53:251–266, 1980.

    Google Scholar 

  38. Lewis, C.G., Sheps, I.The Sick Citadel: The American Academic Medical Center and the Public Interest. Massachusetts O.C.H., Inc., 1983. Pp. 100.

  39. Saward, E.W., Fleming, S. Health Maintenance Organizations.World Health Forum. 2:298, 1981.

    Google Scholar 

  40. Saward, E.W., Some Caveats for Medical Schools. In Somers, A.R.The Kaiser Permanente Medical Care Program—A Symposium. Oakland, California: The Commonwealth Fund, New York, New York, 1971. Pp. 183–188.

    Google Scholar 

  41. Hoft, R.H., Glaser, R.J. The Problems and Benefits of Associating Academic Medical Centers with Health-Maintenance Organizations. Henry J. Kaiser Family Foundation,N. Eng. J. Med. 307:1681–1689, 1982.

    Google Scholar 

  42. Sorenson, A.A. The Role of the University of Rochester Medical Center in the Evolution of Local HMO's. In Hudson, J.I., Nevins, M.M., eds.Health Maintenance Organizations and Academic Medical Centers: Proceedings of a National Conference. Menlo Park, California: The Henry J. Kaiser Family Foundation, 1981. Pp. 244–264.

    Google Scholar 

  43. Petersdorf, R.G. Foreword. In Proceedings of a Symposium Convened by the Association of American Medical Colleges to Address Issues Involved in Adapting Clinical Medical Education to New Forms and Sites of Health Care Delivery.J. of Med. Educ. 1987.

  44. Bosch, S.J. An Experiment to Change Medical Education and Medical Care in Argentina.Soc. Sci. & Med. 7:373, 1973.

    Google Scholar 

  45. Lewis, C.G., Sheps, I.The Sick Citadel: The American Academic Medical Center and the Public Interest. Massachusetts O.C.H., Inc., Pp. 99.

  46. Harvey, A.M., Abrams, S.L.For the Welfare of Mankind: The Commonwealth Fund and American Medicine. The Johns Hopkins Univ. Press, Baltimore, 1986. Pp. 305.

    Google Scholar 

  47. Bosch, S.J., Deuschle, K.W. The Role of a Medical School in the Organization of Health Care Services.Bull. NY. Acad. Med. 53:449–464, 1977.

    Google Scholar 

  48. Bosch, S.J., Merino, R., Rose, D.N., Deuschle, K.W. Can Academic Medical Center Health Services Research be Useful in Community Development?Mt. Sinai J. Med. 52:744, 1985.

    Google Scholar 

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Authors and Affiliations

  1. Department of Community Medicine, Mount Sinai School of Medicine, One Gustav Levy Place, 10029, New York, NY

    Kurt W. Deuschle MD

Authors
  1. Samuel J. Bosch MD
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  2. Kurt W. Deuschle MD
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Samuel J. Bosch, MD, is Professor Emeritus of Community Medicine and International Health, Mount Sinai School of Medicine; Kurt W. Deuschle, MD, is Chairman Emeritus and Professor of Community Medicine, Mount Sinai School of Medicine.

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Bosch, S.J., Deuschle, K.W. HMO development in an academic medical center: The rise and fall of a prepaid health program in New York City. J Community Health 18, 183–200 (1993). https://doi.org/10.1007/BF01324430

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