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May 8, 2009 at 10:51 AMComments: 0 Faves: 0

Doctor HMO You

By Katie from SLN More Blogs by This Author

Every day, you come into contact with vendors. The grocer, printer, educator, landscaper, electrician, and endless others provide services that you are willing to pay for. And in each case, no one can tell you which vendor to buy from, or what goods you may or may not purchase. Health care professionals are vendors too. They differ from other providers because the service they offer generally meets an immediate need, which doesn't exist when you're shopping for a new sweater or perennial plant. And because that necessity can turn to desperation, and will eventually touch every citizen, the powers that be can more easily place restrictions and requirements on the system. This means that when it comes to health care vendors, you might not have the freedom to shop where you want, and buy the best product for your situation. Basically, we're talking about HMO insurance, which is sort of like a health care middle man that determines which clients have access to which products. Health Maintenance Organization (HMO) is a type of health plan that can cost less than other insurance, but in turn allows less choice on the part of the client (who has become a patient). Typically, patients contribute to an HMO plan, and pay a small co-pay at the time of service. However, they must see a primary care provider (PCP) that their plan is in contract with, and must obtain referrals from that PCP any time they want to see a specialist.

"More and more patients are getting their health care through employers, who go through HMOs. The doctor-patient relationship is no longer a direct communication centered on care."

The HMO system as we know it was developed by the U.S. Congress in the 1970s, as a response to escalating health care costs. Granted, with more government subsidization, costs would go down for patients. But there would also be limitations on what doctors they could see and what services they could access.

One school of thought blames previous government subsidization of health care for the rising costs in the first place. According to this thinking, further government involvement in a process that was already hindered by their subsidization would only be a bandage, and not address the real problem at all. Others feel that the reduction of cost was a more pressing issue, and hope to work out the problems of HMOs and other insurance providers down the road. In the meantime, more and more patients are getting their health care through their employers, who go through HMOs. The doctor-patient relationship is no longer a direct communication centered on care. The vendor and client are both so bogged down with red tape that the care becomes secondary to the guidelines. On top of all of this, the incentives are backward: health organizations are actually rewarded when their costs go down. This means that a patient might become a cut corner. The U.S. health care system is not going to heal overnight. No matter who is ultimately responsible for the current mess, the processes are too big and too established to change quickly. The surest way for change is the education of the people, and their work to inform those around them. Just as with your groceries, vehicles, and shoes, you have the right to purchase what you want, and know what you're getting.


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