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The Role Of HEALTH MAINTENANCE ORGANIZATIONS In Nigerian Health Sysy - Health - Nairaland

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The Role Of HEALTH MAINTENANCE ORGANIZATIONS In Nigerian Health Sysy by obawale(m): 1:34pm On Aug 11, 2015
Managed Care is the enrolment of patients into a plan that makes capitated payments to health care providers on behalf of its members, thus shifting the financial risk for health care from patients and payers to providers. The intent of this shift is to provide incentives to health care professionals to reduce their utilization of resources, ideally through measures such as health promotion and disease prevention among the group's members.
Health Maintenance Organization as a terminology was coined by Dr. Paul Elwood (USA) in the early 1970’s as an advancement in the development of Private Provider Group Practice then prevalent in California, USA.
HMOs are designed to deliver quality health care to a designated population in a cost effective manner, through health care providers paid either a fixed budget or discounted fees. They use a value-driven system of managed care to provide affordable health services
The financial burden of risks of over-using health services are borne by the HMO, its service providers or a combination. There are various explicit and implicit rules that govern the risk-sharing. The member must receive health care from HMO - approved provider.
HMOs have exclusive provider networks. They may also use primary care providers (PCP) as gatekeepers. Gatekeepers are responsible for arranging a patient’s referral to a specialist or admission to a hospital.

While most HMOs use gatekeepers, some HMOs have open access plans. These plans allow the patient to choose any PCP or specialist in the network without a referral.

Many HMOs also use reimbursement systems to encourage providers to be more cost conscious. HMOs may contract directly with physicians in the community, or may contract with networks of physicians. This arrangement is called a network or IPA model HMO

HMOs may have their own physicians on salary or in an exclusive contractual arrangement. This is called a group- or staff-model HMO.

Other major characteristics of HMOs:
They assume contractual responsibility for assuring the delivery of a stated range of health care services including at least in-patient hospitalization and ambulatory care services.

They serve a voluntarily enrolled population. Health care is delivered through a proper referral system.

The premium is fixed, regardless of utilization.

There may be a fixed co-payment (direct or indirect) for use of certain services.

The HMO assumes some of the financial risk or gain.

One of the best HMOs that i recommend is www.unitedhealthcare-ng.com

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Re: The Role Of HEALTH MAINTENANCE ORGANIZATIONS In Nigerian Health Sysy by obawale(m): 3:02pm On Aug 11, 2015
HEALTH IS WEALTH

JOIN US AT OUR MONTHLY FITNESS & WELLNESS EXERCISE CAMPAIGN

Lagos Venue: Teslim Balogun Stadium Car Park, Surulere (Every 2nd Saturdays of the month)

Abuja Venue: Training Pitch with Track, Through Gate C, National Stadium, Abuja. (Every 3rd Saturday of the month)
Side Attraction: Health talk and free medical Check up. Be There!!!

www.unitedhealthcare-ng.com
Re: The Role Of HEALTH MAINTENANCE ORGANIZATIONS In Nigerian Health Sysy by obawale(m): 8:49am On Aug 13, 2015
U are invited to United Healthcare International Ltd. monthly aerobics exercise and medical check @ 7:00 am on the 15th of August @ the National stadium Abuja. Come with your family & friends. Thank you.

http://unitedhealthcare-ng.com/

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