Operations and Performance of Health Maintenance Organizations: A Synthesis of Findings from Health Services Research - Executive Summary

摘要

This synthesis of the available information on Health Maintenance Organizations (HMOs) includes historical and definitional perspectives; organizational and environmental factors influencing performance; a summary of what is and is not known about various dimensions--the claims, the expectations, and current research findings of HMO performance. HMOs often have been perceived as an answer to current problems in the health care system by serving their enrollees and providing a stimulus for change within the health care system. This review and analysis of existing research information is designed to focus on the major policy concerns and operational problems faced by state and local government officials and those in the private health care sector responsible for policy development and implementation, program planning and regulation, service delivery, and the purchasing of health benefits.