Alternative Medicine - Healthcare

Alternative Medicine - Healthcare

Topic # 1

Healthcare cost containment is a major initiative of all healthcare policy reforms, discuss how the lessons learned from HMOs might be used to effectively design and implement cost containment programs that maintain or improve the quality of care and outcomes.

A (HMO) i.e. Health Maintenance Organization is an association that offers or makes arrangement for well-organized healthcare insurance, benefit plans of healthcare that are self-funded, and individuals and other bodies in the U.S. acts that work as a liaison with the providers of healthcare such as doctors, hospitals etc on a prepaid source. HMOs need members that could choose a (PCP) i.e. Primary Care Physician, who is a doctor and works as a 'gatekeeper' for directing access to healthcare services. Those PCPs are normally family doctors, pediatricians, internists, or general practitioners. Excluding the medical situations of emergency, patients require a referral form from the Primary Care Physicians for seeing for any doctors or specialist, and the gatekeeper is not able to authorize such referrals till then it could deem as compulsory by the guidelines of HMO (Elizabeth & Robert, 2001).

HMOs also work for managing the healthcare with the help of usage review. That refers to do monitoring of doctors for seeing that either they are performing fewer healthcare services to their patients as compare to other doctors, or more. Most of the time, HMOs provide preventive care measures for a relatively lower co-payment or sometimes for totally free, as it helps them in keeping members from improving a preventable provision that would need a quality-oriented compact of healthcare services. Some services, like out-patient mental healthcare, are restricted, and are expensive sorts of care, treatment, or diagnosis may also not be covered. Elective services and experimental treatments those are not medically essential such as, plastic surgery, are also never covered (Elizabeth & Robert, 2001).

Other alternatives for care management are done through effective management of cases, in which the identification of cases are done of those patients who go through with catastrophic, or the diseases are managed, in which the identification is done of patients with specific chronic diseases such as asthma, diabetes, or different kinds of cancer. In each case, the HMO takes a better involvement level in the care of patient, assigning an individual to professionally manage the case of patient or group of several patients with same diseases in order ...