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Definition
Health maintenance organizations (HMOs) are a type of insurance plan (See “Health Insurance”) that utilizes a network of healthcare providers that agree to deliver care based on standards established through a case management process. HMOs distinguish themselves from traditional insurance plans through their managed care approach of integrating the insurer role of financing medical care with the provider role of coordinating the delivery of medical services.
Overview
The modern HMO movement can be traced to the early 1970s, a time characterized by runaway healthcare costs and inadequate access to medical services. Under a traditional health insurance model, patients have the freedom of choice of healthcare provider and healthcare providers receive a fee-for-service (FFS) (See “Fee-for-Service”) administered to a patient. The generous coverage and reimbursement and limited utilization oversight under the traditional insurance model create a misalignment...
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Dugan, J. (2021). Health Maintenance Organizations. In: Gu, D., Dupre, M.E. (eds) Encyclopedia of Gerontology and Population Aging. Springer, Cham. https://doi.org/10.1007/978-3-030-22009-9_298
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DOI: https://doi.org/10.1007/978-3-030-22009-9_298
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