Health maintenance organizations
Introduction (Psychology and Mental Health)
From the early part of the twentieth century until the 1960’s, many employers provided prepaid, limited medical plans. Their popularity waned considerably in the late 1960’s, however, when health care costs soared and pressure grew for the government to intervene. In 1973, as part of a health care cost containment initiative, the U.S. Department of Health and Human Services passed the Health Maintenance Organization Act to improve the efficiency of the national health care system. This act helped secure HMOs as health care providers and removed legal barriers that had previously inhibited their development. It required employers with fifty or more employees to offer federally certified HMO plans. In the 1980’s, the number of HMOs in the United States doubled. By 1996, almost 25 percent of the U.S. populace was enrolled in HMOs, and by 2001 this number had increased to almost 30 percent.
HMOs contract with health care providers, who become part of a network that provides health services to HMO patient members at a fixed, prepaid fee regardless of actual medical costs or the number of times they are seen in the office. In return, the HMO ensures a steady flow of patients to the providers. The major goal of HMOs is to provide quality health care while reducing health care costs. The premise is that because of the reduction of out-of-pocket expenses, HMO patient members will seek medical treatment more routinely. As such, a...
(The entire section is 447 words.)
Mental Health Care (Psychology and Mental Health)
Outpatient mental health services are often limited in HMO plans. In fact, many provisions for long-term mental health needs are minimal. Many HMO plans increase a patient’s copay for extended mental health treatment. For example, a plan may require no copay for mental health visits one through five, a five-dollar copay for mental health visits six through ten, and a fifteen-dollar copay for additional visits. There may be no copay, however, for inpatient mental health treatment because such treatment often focuses on crisis intervention and short-term therapy. In addition, many HMOs depend on the primary care provider to treat mental health disorders instead of referring patients to licensed mental health care providers or psychiatrists. Treatment for addiction services is also limited. Patients often have a higher copayment and a limited number of times that they can be treated for addiction-related issues.
The Mental Health Parity Act of 1996 began the process of ending the practice of providing less insurance coverage for mental than for medical illnesses. However, it only pertained to plans that already covered mental health care, and although mental illnesses were covered, it did not include addictions. The Mental Health Parity and Addiction Equity Act of 2008 requires that by January 1, 2010, mental health and addiction treatment copayments and treatment limitations could not be any more restrictive than medical...
(The entire section is 238 words.)
Sources for Further Study (Psychology and Mental Health)
American Psychological Association. “Wellstone-Domenici Mental Health Parity Act of 2008.” http://www.apapractice.org/apo/in_the_news/. Reviews questions and answers regarding the changes regarding coverage for mental health reflected in the 2008 Mental Health Parity Act.
Kongstvedt, Peter. Managed Care: What It Is and How It Works. Sudsbury, Mass.: Jones & Bartlett, 2008. The author provides a historical overview of managed care, concepts, and practices of the managed care industry.
Marcinko, David, and Hope Hedico. Dictionary of Health Insurance and Managed Care. New York: Springer, 2006. The authors provide up-to-date information, definitions, and terminology related to the health care industry and managed care.
National Alliance of Mental Illness. “The Mental Health Parity Act of 1996.” http://www.nami.org/Content/. Offers a summary of legislation regarding the Mental Health Parity Act of 1996.
(The entire section is 129 words.)