Managed Health Care, A System Gone Wrong
by
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This book is about how the consumers and practitioners of managed health care can better understand the changes that are going on in the health care business today. It will explain, in the simplest of terms, how these changes affect you as it relates to your care. It focuses primarily on what are known as Managed Care Organizations, (MCOs) and Health Maintenance Organizations, (HMOs). These companies are in the business of providing health care on a pre-paid basis. That is, they receive money before they provide the care. These companies are growing, enrolling more and more people each year. The government is encouraging Medicare recipients to enroll in them and some states already have their own models for their Medicaid programs. Further, as these pre-paid organizations grow, the bigger, private ones are merging with the smaller ones, producing monoliths of pre-paid health care. More and more of them have started out as for-profit companies, while others formerly non-profit have converted, or are converting to for-profit. This profit motive alone has enormous implications to the consumer of health care, affecting the very source and quality of the care you receive.
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About the Book
Today's HMOs come into a great deal of criticism, yet few people understand their inner workings. This book describes how they operate and why they elicit such criticism. Written with the general public in mind, it gives an overview of the current situation, a history of the HMO industry and how they function, how the federal government got involved, how and why the early models failed, how the large for-profit HMOs entered the picture and how they work, and their impact on the national health care scene. It also presents recommendations on what should be done to provide consumer protection. Finally, it gives users and potential users recommendations, and physicians and other health care provider's recommendations, before becoming involved with HMOs.
About the Author
The author has spent over 12 years in the health care industry, much of which was involved in the early stages of HMO development, including executive roles in both for-profit and non-profit HMOs. He played a leading and active part in establishing one of the first federally qualified HMOs in the nation. After many years, he left the HMO industry thoroughly disheartened at the failure of the industry to meet it expectations. While engaged in other business pursuits, he was frequently called upon by several physician acquaintances to offer advice on their roles in joining and participating in HMOs, which led to a consulting assignment to a physician group (IPA). This assignment convinced him that the HMO movement had strayed far from its original intent and required someone to write about it.