Health Maintenance Organizations and Health Care Planning in the Pennyrile Area Development District.

摘要

The feasibility of establishing health maintenance organizations (HMOs) within the framework of a regional health care delivery system is explored for the five southwestern Kentucky counties comprising the Pennyrile Area Development District. The report describes the HMO concept, both in general and in relationship to the Pennyrile area and a regional system of health care. Three different HMO models are described: the foundation plan model, the free-standing prepaid group practice plan model, and the hospital-based prepaid group practice plan model. The basic concept, advantages, and disadvantages of each are pointed out. HMO components are described (e.g., open enrollment, preexisting health conditions, consumer participation, financing, malpractice protection), and HMO-related issues are discussed. A strategy for regional coordination, planning, development, and operations is proposed. The strategy, based on the creation of a formal organization for health care development in the Pennyrile district, is patterned after several regional health system development corporations funded by the Experimental Health Systems Programs of the National Center for Health Services Research and Development, DHEW. Demographic, health status, and health care resource data for the Pennyrile district are appended.