Promoting health and preventing disease some thoughts for HMOs

Many of the predisposing factors to current morbidity and mortality relate to societally approved behaviors. Attempts to intervene or change behavioral patterns after a chronic condition is clinically established are limited in effectiveness. Because health maintenance as a conceptual activity occurs outside the medical care delivery system, organizations committed to health maintenance must be active in the school, workplace, and the community if they are to be effective. The concept of prepaid health insurance has been extended in the HMO Act to include responsibility for the maintenance of health and the prevention of disease. This paper provides a three stage model for preventive and promotive activities in HMOs. The case is made that HMOs have a responsibility to provide health promotion and disease prevention services beyond the clinical setting.