Health Maintenance Organizations (HMOs)

Health Maintenance Organizations (HMOs) are the primary vehicle for managed health care in the United States. An HMO is an organizational structure that insures participating members for health-care-related expenses through its coordination of the financing elements of medical care with the care provision aspects. In their role as insurer, provider, and administrator for health care coverage, HMOs attempt to fulfill three often conflicting agendas: the provision of high quality health services; the reduction of inefficiencies, both operational and economic, in such services; and the generation of financial profits for the owners of care provider systems.

The underlying philosophy behind the development and implementation of health maintenance organizations is the concept of managed care. Managed care is an approach to the provision of health care services that ...