Health Maintenance Organizations Essay, Research Paper

Throughout history, America has always strived for freedom and quality of life.

Wars were fought and people died to preserve these possessions. We are now in a

time where we may see these ideals crumble like dust in the wind. Health

Maintenance Organizations, HMO?s are currently depriving millions of people

from quality health acre and freedom of choice. This is occurring because people

who are enrolled in HMO?s are unable to choose the doctor that they want. Also

patients lose the quality of care because HMO?s interfere with the health care

providers decisions. The Health Maintenance Organization has been proven to

?sometimes interfere with physicians? exercise of sound medical judgement

and avoid covering necessary medical care, causing members to either pay out of

their own pockets or go without? (Schlossman). This means that the insurance

company does not really care about you. The insurance company only cares about

how much money it has to spend on you as a person and if you need a type of

special care that cost money either you can pay for it your self or just go

without the care that is needed. This interference often compromises the

patients? ability to have freedom of choice in selecting a provider and to get

the best quality for their health care needs. This freedom of choice is the

ability to choice the doctor that you want as a doctor. Yet instead HMOs pick

the doctor for you. All over the United States HMO?s have denied patients the

medical care which they need. In Charlotte, North Carolina, for example, a boy

named Ethan Bedrick was born with cerebral palsy. His doctors said that in order

for him to be able to ever walk, he would need extensive therapy. Yet according

to HMO policy, patients are only allowed a maximum of fifteen therapy sessions

per year; therefore, his health plan said ?NO.? The HMO said no when a

little boy said please help. This proves why HMO?s frequently deprive patients

of the optimum quality of life. This little boy?s future of being able to walk

was crushed by an insurance company that was so money grubbing greedy that it

could not stretch the rule for this case. Since the boy?s therapy is not being

paid for the HMOs gets a bonus in their paycheck. They took the money that was

supposed to go to the therapy and put it into their pockets. An epidemic has

occurred in most senior citizens lives. Since January 1, 1999 440,000 senior

citizens have lost their HMO privileges. In essence, HMO?s decided to

arbitrarily eliminate the senior citizen plan. The sad reality is that many

members who subscribed to these particular HMO?s for its senior citizens

package are out of luck and without medical coverage. For many people over the

age of 65 who once had HMO benefits are now scrambling to find a new insurance.

There are people like Allen Martin from New York, who is over the age of 65. Due

to a severe disease his kidneys do not work. As a result he needs dialysis,

(which is when the waste material is flushed out of the body) three times a

week. This process is extremely expensive costing hundreds of dollars each time

and what was once paid for by the HMO, but now he has to find some way to pay

for it on his own. In many cases doctors are unable to tell a patient the

limitations of their particular HMO and how it interferes with the ability to

provide good medicine. This is called the ?gag rule?. These gag rules do not

allow the doctors to say anything bad or against HMO?s. Also the rules

restrain doctors from telling the patient certain things that HMO?s do not pay

for such as special procedures that might benefit the patients condition.

Doctors who work with HMO?s have to sign a contract. This contract states that

a doctor is unable to tell patients certain things. Yet in frequent cases

doctors have felt limited by their contract with HMO?s. This is because they

want to tell patients important facts, but are unable to because of the

contract. If the doctor?s break this agreement, they stand to lose their

contract with the HMO. The Health Maintenance Organization created a situation

where patients have lost the ability to select the doctor of their choice. In

addition, many plans have something called a ?Gatekeeper?. The gatekepper is

a business man who probibly does not know anything abnout medicine or what to do

in a critical medical situation and makes his descions soley on how much is it

going to cost. The Gatekeeper tells you that you must see a Primary Physician

before you can see a Specialist. This is just one extra step that the patient

must take to get care. This process normally takes an extended amount of time

resulting in an interference in quality of care. Freedom of choice is a

fundamental aspect of being an American. This is being eliminated by HMO?s

whose only concern is making money. These companies seem to have little interest

in the quality of care and the health of the people of this country. Finally,

the health care system in this country is being denied the opportunity to

provide treatment which is based on the decisions of trained professionals, but

rather is being dictated by money managers who profit from preventing care from

being given. The United States has been built upon the principles of choice and

quality. We must not allow these basic concepts to disappear.