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Health care delivery systems in review.

S N Dunmire

    The Journal of Medical Practice Management : MPM
    |March 5, 1989
    PubMed
    Summary

    The health maintenance organization (HMO) industry faces financial and staffing crises, with some executives struggling while others find solutions. The preferred provider organization (PPO) sector also grapples with quality and cost challenges.

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    Area of Science:

    • Healthcare Management
    • Health Economics
    • Managed Care Organizations

    Background:

    • The health maintenance organization (HMO) industry is experiencing significant challenges, including insolvency and physician dissatisfaction.
    • Employer demands add further pressure to the struggling HMO sector.
    • The preferred provider organization (PPO) industry faces its own set of issues, namely quality assurance and cost containment.

    Purpose of the Study:

    • To examine the current state of the health maintenance organization (HMO) industry.
    • To identify the challenges faced by HMO executives and their impact.
    • To briefly address the concurrent issues within the preferred provider organization (PPO) sector.

    Main Methods:

    • Qualitative analysis of industry trends and executive experiences.
    • Review of financial and operational challenges within managed care.
    • Comparative overview of HMO and PPO industry pressures.

    Main Results:

    • HMOs are plagued by insolvency and physician discontent, leading to executive resignations or bankruptcy for some.
    • A subset of HMO executives have successfully navigated financial and physician staffing difficulties.
    • PPOs are concurrently addressing quality assurance and cost containment.

    Conclusions:

    • The HMO industry requires innovative solutions to overcome systemic issues.
    • Executive leadership plays a critical role in navigating managed care challenges.
    • Both HMOs and PPOs face ongoing pressures related to financial stability, physician relations, and service delivery.

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