Introduction
A managed care organization (MCO) is a company that provides medical services to individuals who are enrolled in managed care programs. There are several types of MCOs, each differing in its setup. Each MCO has a delivery system comprising healthcare providers, such as hospitals, laboratories, and doctors’ offices. The Health Maintenance Organization (HMO) is one such MCO model (US Legal, Inc., n.d.). Developing and enhancing ethical and professional patient cooperation within a single approach involves several HMO models.
Health Maintenance Organization Models
A staffing model is a type of health insurance framework that can maximize the delivery of moral patient care. The HMO must provide ethical healthcare by utilizing the best model or structure, specifically in terms of structure and strategy. The staff model, network model, individual practices pooling model, and group model are the four primary models of HMOs (US Legal, Inc., n.d.).
Staffing Approach
In the internal model, the HMO hires doctors to provide medical care exclusively to its medical participants. Furthermore, many physicians can offer members most of their medical services even though they do not work for the health insurance fund, based on a contractual arrangement (US Legal, Inc., n.d.). Contractual connections are acceptable when the organizations that recruited the doctors will not let the health insurance fund hire them.
The main factor is that doctors primarily treat clients of the health insurance fund for their primary medical needs. Doctors must be under the HMO’s control for the staffing model to be considered regular. If necessary, an HMO may own healthcare delivery systems, such as hospitals.
Contractual and Network Approaches
To supply members with healthcare services, an HMO that employs a team model enters into agreements with one or more teams of medical specialists. Unlike the standard model, doctor groups under the group model are not connected to a single health insurance fund. As a result, they can offer medical services to one or more health insurance firms. The organization could offer comprehensive, primary healthcare or specialized medical services (US Legal, Inc., n.d.).
Most, if not all, of a physician’s liabilities and assets related to their medical practice must be transferred to the groups to which they belong. A group of independent doctors who have joined forces to offer healthcare services under the Individual Practice Association (IPA) model is not fully incorporated into their practice. Although each doctor operates independently, these doctors provide healthcare services to health insurance companies. Participating doctors use the IPA to enter into agreements with health insurance providers. Counties often develop IPAs in the US on behalf of physicians (US Legal, Inc., n.d.).
In the network model, the HMO concurrently hosts two or three of the earlier-mentioned types. For instance, a health insurance fund may engage physicians, enter into agreements with physician groups, and simultaneously retain physicians’ services through IPA contracts. Health insurance providers that focus on offering affordable managed care services often adopt this strategy and structure.
Ethical Implications
An HMO’s organizational structure or business model greatly influences how ethically it treats its patients when providing medical treatment. Adopting a methodology that maximizes moral delivery is, therefore, crucial. The doctor-patient connection is one of the key elements influencing the quality of medical services provided.
According to a prior study, managed care models can have a significantly negative impact on physician-patient interactions. When the selected model restricts patients’ access to doctors and the amount of time a doctor spends with patients, adverse effects frequently result when the patient’s faith in the doctor is damaged (US Legal, Inc., n.d.). Therefore, the best NPV model is one in which such impacts are low, if not absent altogether.
The ethical provision of healthcare services is likely constrained by models in which HMOs recruit doctors on temporary contracts. Doctors have brief interactions with patients in both the group model and IPA contracts. Contracts for doctors may be renewed, although they are not always renewed. In such situations, physicians often fall short of forging long-lasting bonds with patients, which is essential for advancing moral care for patients who switch doctors and struggle to trust the new one. These models allow doctors to work for many HMOs, which may limit the time they can devote to each patient. Patients’ access to physicians can also be constrained.
Although HMOs utilizing the network model are only allowed to employ physicians, they may also utilize alternative models, which lessens the possibility that all patients would receive ethical healthcare (Reid & Silver, 2013). Thus, the internal model is the most effective organizational design for delivering ethical services. The concept not only averts the aforementioned adverse effects but also encourages doctors to follow the HMOs’ standards of practice.
The staffing model most effectively encourages HMOs to provide healthcare services in an ethical manner. The paradigm enables patients to access doctors, allows doctors to spend enough time with patients, and increases the likelihood that patients will develop a rapport with doctors they can trust. The methodology also increases the likelihood of ethical treatment being provided. The group, network, and IPA models have flaws that might prevent medical treatments from being provided ethically. However, they are relatively successful in identifying ways to enhance the ethical delivery of services.
Reference
US Legal, Inc. (n.d.). Managed care and HMOs – healthcare. Web.