潇湘渌水 @ 2010-06-01 21:50
从Chou的博客看到他写这段话，引发了我trace HMO：
“从整体的角度看，若要让大部分的医疗照护机构将疾病预防及健康促进任务纳入其正规宗旨中，必须透过财务的机制，也就是让医院从事疾病预防及健康促进不只是一件理想而已，而且还是有报酬的服务，才能全面将医院导向。当初美国HMOs是有这样的理想及财务机制，但起初遭到医师团体的抵制，后来虽然国会立法而快速发展，最后因为病人的就医选择权受限而逐渐没落。未来不知道是否会有更有创意的医疗财务/保险制度被规划出来？” http://thchou.blogspot.com/2010/05/prof-griffith2.html
The earliest form of HMOs can be seen in a number of prepaid health plans. In 1910, the Western Clinic in Tacoma, Washington offered lumber mill owners and their employees certain medical services from its providers for a premium of {post.abstract}.50 per member per month. This is considered by some to be the first example of an HMO.
In 1970, the number of HMOs declined to less than 40. The enactment of the Health Maintenance Organization Act of 1973. This act had three main provisions:
1. Grants and loans were provided to plan, start, or expand an HMO
2. Certain state-imposed restrictions on HMOs were removed if the HMOs were federally certified
3. Employers with 25 or more employees were required to offer federally certified HMO options alongside indemnity upon request
This last provision, called the dual choice provision, was the most important, as it gave HMOs access to the critical employer-based market that had often been blocked in the past. The federal government was slow to issue regulations and certify plans until 1977, when HMOs began to grow rapidly. The dual choice provision expired in 1995.
HMOs often have a negative public image due to their restrictive appearance. HMOs have been the target of lawsuits claiming that the restrictions of the HMO prevented necessary care. Whether an HMO can be held responsible for a physician's negligence partially depends on the HMO's screening process.[citation needed] If an HMO only contracts with providers meeting certain quality criteria and advertises this to its members, a court may be more likely to find that the HMO is responsible, just as hospitals can be liable for negligence in selecting physicians. Despite the fact that the HMO makes medical decisions while controlling the financial aspect of providing care, it is often insulated from malpractice lawsuits.
