HMO Regulation Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. They involve elements such as beneficial health care programs like Medicare for seniors and Medicaid for the poor. HMO’s are sometimes referred to as managed care programs, which involves participation through clinics, physicians and insurance companies. Other essential parts of HMO’s include prescription drug plans, such as distribution and cost, and they are also important for information needed by emergency room residents in cases of emergencies. Although HMO's are not always seen as positive and helpful institutions, they are definitely important when it comes to medical care. Most of the criticism comes from consumers using these HMO’s and the politicians implementing their procedures. Some of the major problems involved are denial of treatment by physicians. This has to do with the people they see and what people will receive as far as treatment. According to the Associated Press, “Consumers who have been denied a treatment that the HMO says is not covered, or who inadvertently fail to follow HMO guidelines in seeking treatment and are therefore denied reimbursement, will continue to have little recourse.” [12] Basically not much is being solved or controlled.HMO’s and managed care programs have been subjected to countless regulations and attempted reforms. HMO’s are a combination of doctors and insurance companies that are formed into one organization. They provide treatment to their members at a fixed cost and decide on treatment based on the severity of the patient’s ailments. HMO's main concerns are to control costs and provide the best treatment possible to their consumers using their programs. The reasoning behind this is to keep patients healthy so no further treatment is needed. A lot of the time these org...
