COMPARISON PAPER

Comparison Paper

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Comparison Paper

Introduction

HMO is an acronym of Health Maintenance Organization that is a (MCO) Managed Care Organization, which made their way into health care scene in the year 1910. HMO offers a health insurance coverage form that is contented through physician, hospitals and other providers who have agreements with HMO. This contract refers to a two way contract as more patients received by HMO then they will offer their services at a cut price. This contract permits the HMO to allege a lower premium on monthly basis that is actually a gain over indemnity insurance, ensuring that its affiliates are keen to bear by additional limitations.

Preferred Provider Organization (PPO) refers to a health care plan which offers covered service at cut rate for policy takers under the network of health care providers. PPO was first seen in the United States around late 1970s. The organization also offers coverage for services provided by providers of health care, other than the network of PPO; in general, subscribers pay a greater percentage of service cost. For preferred provider, PPO will disburse a greater portion of the cost of service, while pay less amount for non-preferred providers.

Discussion

Similarities between HMO and PPO

Both Health-maintenance organization and Preferred-provider organization offers health insurance that can be given independently and at workplace.

Managed Care Organizations

PPOs and HMOs, both are organized health care organizations, and refer to large organizations that handle the claims of family and individuals, as well as, acts as a mediator between the doctor and the patient. In the United States, managed care organizations are widespread type of insurance.

Who Provides

Hardly ever do workers have an option to choose between PPO and HMO. HMO ten tend to be more often used by corporate clients, while large retail clients often offer PPO plans. Companies provide these benefits in a number of ways; can provide paying options in diverse ways to pay packets; proviso necessitate that worker must work for certain period of time for eligibility; and there can be alternatives of how much coverage employee wants (Marya, 2011).

Network of Providers

Both MCO (managed-care organizations) have in favor of providers' network. This refers that certain doctors and hospitals acknowledge insurance with PPO or HMO, and definite ones cannot. Such network is suggested with a PPO, as it can be selected from any physicians in the network, and wander away from physicians on the catalog add to the expenses. HMO needs to select a PCP (Primary-Care Physician) from a catalog that deals with all recommendations to medical experts and other health check needs.

Utilization Assessments

Both PPO and HMO providers employ what are termed as utilization assessments. Such are reviews carried out by the businesses to keep record that how many dollars each patient has to bear on medical visits. Such course of action tries to decrease the cost on what the organizations considers as treatment that is not necessary. These assessments may be hard-hitting on HMOs and PPOs members, as an ...