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For the past few years there has been much controversy regarding the issue of health maintenance organizations (HMOs) and their treatment of patients. There are many problems occurring within this type of system and not nearly enough solutions. This paper will point out some of the major problems with health care in the United States and discuss some possible solutions for the future.

The most important thing to understand is the way in which managed care actually works. It is a health care network where costs are restricted through utilization management. In this case, a primary care provider serves as the arranger for access to specialty care. Patients do not seek help from the specialists themselves. Instead the primary provider is left responsible for finding a more reasonable doctor at a more reasonable price. Most of the time physicians within managed care systems are paid as employees or receive a flat fee per patient per year. Patients using managed care systems usually have the option of choosing a primary care provider within the network, or paying an additional "out-of-pocket" expense to choose their own provider outside of the network. Both HMOs, and PPOs (preferred provider organizations) are examples of

Allowing patients to sue their HMO is a law that has not yet been passed by Congress. However, the result of it would most likely decrease the corporate power of HMOs causing them to focus more on their individual clients, and less on their overall monetary gain.

As a result of the trauma she was subjected to, Herdrich sued her doctor and her HMO alleging that, "the HMO's policy of paying doctors to keep down costs- including costs for diagnostic testing- had compromised her care." Although her doctor had in fact mishandled the case, a federal law called ERISA blocked her accusation against the HMO. This law protects employee benefit plans (including many managed-care organizations) from lawsuits.

The main problem with this law is that it prevents HMOs from taking responsibility for their actions. If improper treatment of a patient occurs based on the financial position of an insurance company, who should be taking the blame? If the HMO provides its physicians with incentives in order to keep their costs down and make the stockholders profit, then it is the patients who will suffer. In this situation the patients should be considered the stakeholders, or the ones who have something at stake. Here, it is their health. Kenneth Goodpaster tells us in his article titled "Business Ethics and Stakeholder Analysis," that when it comes to the decision making process, ethically responsible management includes careful attention not only to stockholders but to stakeholders as well (White 205). Often times these managed care organizations are manipulating the system in order to make a financial profit for their company. In order to save money they may use certain processes !

One case study in particular involves a 33-year-old woman who lives in Bloomington, IL. Cynthia Herdrich went to her HMO doctor claiming to have a pain in her abd

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Approximate Word count = 1251
Approximate Pages = 5 (250 words per page double spaced)

Category: Miscellaneous