Health maintenance organization (HMO) is the organization of the medical securing, support offering its clients both group medical service and services of medical insurance. It is usually responsible for providing of such services in a strictly certain region (district, state), raising payment on the basis of the fixed regular upfront payments (usually monthly), which do not depend on an amount of rendered to the patient services. Such organization owns a medical center or engages other medical centers, clinics and independent doctors in rendering service that together with it divide risks connected with the cost of the medical providing in the cases when actual charges on treatment exceed the sum of payments, got from a patient. Development of such organizations is in a great deal related to the cheapness of services, and also with acceptance of the proper legislation which is known as HMO Act of 1973. In the year 2000 about 77 per cents of Americans got services according to such a scheme. Large organizations must have the certificates of accordance to the federal standards (federally qualified HMO).
There 4 main types of organizations which can be distinguished in HMO. One of them is the group organization of medical security. They are called group model HMO, they conclude contracts with different doctors-specialists. The next group is a network organization, so called network model HMO that conclude contracts about providing of services with a few medical centers). The third type is presented by the organizations, which work on principle of “service on the spot”. They are called Point of Service plan; open-ended HMO; opt-out HMO; leaky HMO. And the last type is the organizations with their own staff of medical workers. Such staff models HMO possesses own medical establishments.
But not taking in account the seeming ideality health care planning and its development, it is obvious that the problem of medical care is one of the sharpest in the USA. Charges on medicine make up an astronomic sum – approximately 14% of gross domestic product of the country, while a lot of people in the USA do not have opportunity to pay for visiting the doctor and purchase some medications.
From year to year the native citizens of the USA expend more and more money on medical aims. Thus, expenses on the purchase of medicines grew more than on 15% (according to the information of government agency – Centers for Medicare and Medicaid Services). For example, an ordinary visit to therapeutist on the average in the country costs 120 dollars. It is a round sum of money for the average statistical man of the country.
Annually more than 18 thousand of Americans perish only because they do not have medical insurance, and they are unable to pay medical care. In conformity with a research, conducted by the Institute of Medicine (non-governmental organization which conducts independent examinations in a medical sphere for the USA Congress), uninsured people who suffer from such a terrible disease as breast cancer, have 50 per cents more chances to die, than insured patients . Moreover victims of accidents, diabetics and hypertensive patients have also considerably more chances to part with their lives.
Imperfection of the system of medical insurance directly and indirectly touches all people of country. And the business is not only in social exposure and insecurity of the greater part of population. For example, if a patient who has no medical insurance comes to the hospital, the hospital has no right to refuse him in service and help. Charges on treatment of such a patient are redistributed between patients who have insurances in the hidden way. So, in that turn, it results in the growth of patients’ insurance expenses. Annually different organs of power and level are forced to spend more than 30 milliards of dollars on coverage of poor people expenses, and approximately 5 milliards of dollars, are presented by physicians who often agree to provide medical care free of charge for some uninsured patients. However it does not reduces much the sharpness of this problem.
It goes without saying that the system of medical insurance needs considerable changes, and this problem must be decided on the political level. It is known that democrats and republicans have different claims against the program Medicare, as well as on the whole system of medical defense in the country. In a general way, democrats aspire to create the new government program of medical defense which would guarantee every needy person the certain level of medical care, and republicans suggest maximally to release the system of medical insurance from the state financing and give it on the tax to the market. Bills about indemnification of costs on receipt medications according to the program Medicare have already been repeatedly examined in Congress. May be soon these vitally important laws will be adopted and start working not against patients.