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Time's Up for HMOs This work has been published in the Teen Ink monthly print magazine.


   Health maintenance organization? More like pain maintenance. For the last 20 years,health maintenance organizations (HMOs) have grown at a tremendous ratethroughout the country. Their aim is to control the rising costs of medicine andstill provide good medical care. Somewhere in the organizations' growth, though,a little innocent rabbit called "Patient Care" was swallowed by theferocious lion "Money Maker."

The system shouldchange.

Not too long ago, I had a skin infection in the corner of my eye.In two days, it spread to my cheek. My parents took me to the urgent care sectionof a local hospital we'll call K. Although we had an appointment, we waited anextra hour in the waiting room and another 45 minutes in the exam room. Finally,an unapologetic doctor entered the room.

Without washing his hands, hemoved straight for the rash on my face. After observing it for a few seconds, heannounced he had not the slightest idea what it was. Since he did not think itwas an emergency, he told me to contact my regular doctor, who would then referme to a dermatologist, which would take six weeks. Without further discussion, heleft.

These doctors, who deny access to specialists and the appropriatetreatment at the right time, are the gatekeepers in the HMO system. According tothis doctor, it was not an emergency until the rash on my eye had actuallyblurred my vision. But wouldn't that be a little late?

In HMO plans, theinsurance company takes money from the people it insures and gives a percentageof that to the doctor, whether those patients visit the doctor or not. Themonthly premium for HMO insurance is lower than the private insurance premium.Due to this low cost, more patients sign up with HMO plans.

The biggestproblem with this set-up is that both the doctor and the insurance company havebeen pre-paid. This lowers the quality of treatment from doctors as well as thequality of service from the insurance companies, some of which also provideindemnity plans, which cost more. The patients can choose between the indemnityplan or the cheaper HMO plan from the company, and unfortunately, most choose theHMO plan. The HMO works best for affluent people who never get ill and arewilling to just pay the money for health insurance.

The system shouldchange. Doctors and insurance companies have provided too much unacceptabletreatment. But don't just take my word for it. According to Health Against Wealthby George Anders, an infant's care was delayed by the family's HMO plan. As aresult, the infant's feet and hands had to be amputated. My uncle has hadproblems with his plan, too. Although he went to several doctors during sixmonths of discomfort in his stomach, he was only diagnosed with indigestion.Finally, when he ended up in the emergency room with severe symptoms, doctorsdecided to do a CT scan and found a large malignant tumor, another example ofpoor and delayed diagnosis in HMO systems.

With indemnity plans, theinsurance company pays the doctor after treatment is rendered. This ensures thatthe patient is satisfied before payment. It also makes sure the doctor gives goodtreatment because the doctor gets paid for the amount of work he or she performs.Doctors in private insurances do not prolong the treatment of the patient becausethey want to get paid sooner.

HMO administrators practically train doctorsto do minimum diagnostic tests to control costs. Delayed diagnosis leads topatients staying in the system longer. This forces the patients to pay more tothe insurance company since patients pay monthly.

It often takes six weeksto get an appointment, and in that time, you will make another month's payment.HMO plans are doing exactly the opposite of what they intended, which waslowering the cost of medical insurance.

The system must change.




This work has been published in the Teen Ink monthly print magazine. This piece has been published in Teen Ink’s monthly print magazine.






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