According to Uslegal (2012), Health Maintenance Organization (HMO) employs managed-care system in provision of healthcare services to their subscribers. The subscribers are offered services on the basis of fixed prepaid costs as well as out-of-pocket charges for every visit made. This paper discusses the advantages and disadvantages of HMO to the subscribers as well as to the administrators.
Advantages to Subscribers
HMO is designed to cut cost. Therefore, the insured are able to receive quality services at manageable cost. The subscriber is expected to pay a monthly premium and a copayment for every office visit made. The costs are reliable and relatively predictable as the copayment is on the basis of number of visits made and not the nature of visits and the procedures entailed in the medical care. HMO insurance ensures that their subscribers are accorded comprehensive care. Since the cost at which the health care if fixed, the system tends to keep their subscribers healthy. The providers find the cost manageable if the subscribers are given regular check up than to treat serious illness. The providers also encourage healthy lifestyle among the subscribers. For instance, some providers offer incentives to those who lose weight. Generally, those insured under HMO have access to quality care (West, 2012).
Disadvantages to Subscribers
Even though HMO administrators feel that they have the best specialists who ensure that the subscribers are accorded quality health care services, the subscribers on the other hand feel that they have limited choice and are forced to deal with doctors they may not be comfortable with. The situation becomes pronounced when a subscriber changes employer or in the event that the employer changes plan in which the current primary care physician does not take part in the current plan. Another shortcoming to the subscriber of HMO arises as a result of the protocols that have to be followed. The insured can only see a specialist within the system when referral has been made by the primary care physician. HMO system in designed in a manner that the primary doctor should keep medical costs. Some usually achieve this cost reduction by minimizing contact between their clients and specialists. This may sometimes be risky as the insured may develop a medical complication due to non-specialized medical care (Joseph, cc 2012).
Advantages to the Administrators
Insurance companies often consider a scheme beneficial if they can be able to achieve monetary gain and efficiently offer quality services to their subscribers. Administrators of Health Maintenance Organizations find the insurance scheme beneficial as they are able to save money from it. To the administrators, saving money on health insurance enable them to pay less from their own pockets or otherwise be able to afford covering more of insurance cost for the subscribers (Coxe, 2012).
Managed care plans also enable the administrators to offer quality health insurance services. The administrators assist the payees in selection process by providing them with a network of medical providers. In many cases, the administrators are also convinced that the medical providers are competent enough to offer quality services to their subscribers because they evaluate them before they are registered in the system. This helps ensure that they have credentials and experience that can best meet the needs of the subscribers (Coxe, 2012).
Disadvantages to Administrators
The administrators do not have control on how frequent the insured should visit their facilities. Some subscribers lack self-drive to go for regular check-up, as a result their health conditions deteriorates. The cost of their treatment thus become quite high, this increases the expenses that has to be catered for by the providers. In addition, some subscribers usually reject the primary care physicians they are assigned, this complicates the administrators’ work of ensuring quality services.
HMO is an effective and efficient health care system that values the health of their subscriber. However, the system may mess the health of the insured should the primary care physician be minded more about cutting cost than ensuring the subscribers safety.