Organizational impact on medicine: the HMO concept

This paper examines the role of physicians within the HMO (health maintenance organization) context. The development of HMOs in the United States is traced from their origins to the present time. The literature reveals the emergence of four factors within the practice of medicine; a shift of control away from physicians, the reduction of their prestige, the redefinition of medical quality and increased patient control over the treatment regimen. The paper concludes that (a) while physicians remain relatively powerful, some of their control and prestige are eroded by the organizational setting, (b) HMO physicians must pay greater attention to colleagues, personnel and patients than their fee-for-service counterparts and (c) definitions of medical quality are becoming increasingly rationalized.