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Maria Health Medical Organization Analysis

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Maria Health Medical Organization Analysis

Words: 1006

Subject: Administration & Regulation

The Health Medical Organizations are the structures with the purpose of providing medical care to the people. The HMOs provide the basic kind of insurance plans that provide hospitals and include the services of qualified doctors. In addition, it could be said that HMO is an organization that completely differs from the ordinary insurance companies concerning health.

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Basically, there are two kinds of Health Medical Organizations, which include the open panel type, and the closed panel type. Their principle of interaction is cardinally different. For example, the open panel HMOs represent the structures that correspond to the form of relationship between the health organization and the care provider, which becomes declared by a contract. In its turn, the closed panel HMOs are the structures that include a certain health group of specialists, which directly represents the organization’s name. They require a fixed fee that has to be paid by their patients. Despite their specification, they use different insurance plans. The insurance plans were not always as they are today. As it was stated, before an emergence of the plans of the managed care starting from the year 1990, there were the old health insurances that allowed people to visit any doctor they wanted to (Health Maintenance Organizations and Preferred Provider Organizations, 2016). The open panel HMOs, which relate to the Independent Practice Association (IPA), implement the opportunity for any physician to be involved in the process, from the name of the independent host organization. The difference between the open panel and close panel HMOs is in the approach towards the patients. In the open panel HMOs, a doctor has the rights to observe any patient that he wants. In its turn, the close panel HMOs do not have such an opportunity. Another type of open panel HMOs is known as the network model, which includes the organization’s opportunity of a contract with any individual specialist, medical structure or group. It could be interesting to mention that from the very beginning, the patients that were under the care of the HMOs, had the opportunity to be observed by the doctors that were specially chosen for them, and were able to use various facilities (What is an Open panel HMO? 2016). The Close panel HMOs represent the type of organization that implies the office that lies within its range, the personnel that works in the office and provides services only to those clients, which have the contract directly with the company. That type of HMO’s is called staff model. Another one example of the close panel HMOs relates to the type of group model, which is being reflected in their payment methods, what means that the organization provides the payment for the whole group of specialists, and later it distributes among the members. The main similarity between both types of the open panel HMOs is about their increased freedom concerning their practice and organizational structure, which is mostly built based on responsibility. The open panel HMOs are more suitable for the high qualitative and responsible specialists with a great experience, who can manage to provide the required level of care while not being strictly bound to the organization. The open-panel HMO kind also could appear to be perspective for those doctors who aspire to gain a wide range of independent experience through the constant cognition. In its turn, the differences between those two types are about their functional properties. The first type relates more to the particular individuals, which further build the professional base of the organization on a free basis. In its turn, the type that relates to the network model is more about the organization, what means that it could be influenced by other companies that invest the healthcare projects, and which also could be involved in other kinds of business. The disadvantage of the above-mentioned models is about the possibility for the certain worker to cause harm to the patients, or organization, because of the lack of responsibility and misusage of given rights. The models of close panel HMO’s are different mostly in their approach. In particular, the staff model is a well-organized structural unit, which obligates its workers to follow the strict schedule and discipline. On another hand, the type that is related to group model mostly affects the payment procedure. It is clear that both of the types are similar in their collectivistic basis, organization, what is completely distinctive from the structure of the open panel HMOs. However, the main difference between these two models is about the strict discipline rules. In the case of the staff model, there is a structure that is built on subordination, while in the case of the group model, a principle of collective achievements is promoted. A strongly marked disadvantage of those models is in the lack of freedom that the specialists get for their self-realization. Florida is an example of the American State that has the open panel as the primary type, and particularly, in this case, the network model. It was stated that, due to 2-year healthcare project, NPHLI invites the qualified medical specialists, while the number of participants included three nurses from Florida, members from different States, as well as the specialists from abroad (Florida Public Health Nurse Workforce Initiative: Opportunity Through Crisis, 2005). That case could claim to be the example of the open panel HMOs.

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The HMOs often appear to be a relief for millions of Americans across the country. The following statement is a good representation of some subtle details concerning the health care, because it mentions that “a person who belongs to an HMO program will have access to a “primary care provider” who knows the person’s personal, family, social, and financial situations well enough to coordinate his/her care in an effective way that will use fewer services”. (HMO Insurance, 2013, para. 2). In some degree, it also reflects one of the main ideas that stand behind any HMO, what means that it is necessary to know all of the smallest details to provide a patient with the necessary care. Reference Florida Public Health Nurse Workforce Initiative: Opportunity Through Crisis. (2005). Web. Health Maintenance Organizations and Preferred Provider Organizations. (2016). Web. HMO Insurance. (2013). Web. What is an Open panel HMO? (2016). Web.

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