The greening of the HMO: implications for prepaid psychiatry

Over the past 15 years the health maintenance organization (HMO) movement has abandoned its social objectives in favor of economic ones. The early emphasis on making equitable and affordable health care available to populations has been superseded by concerns about profitability, market share, and consumer appeal. Psychiatric services, which came late in the HMO movement, were characterized by common values and priorities in the closed-panel HMOs of the 1970s. Trends toward independent practice associations (IPAs) and other open-panel systems, rising expectations, and the monetarization of health care are forcing prepaid psychiatrists to reassess their identity and roles.