The Traditional Structure of Medical Care
Physicians & Hosptials
physicians bring patients to hospitals and the hosptials get to bill for them
Physicans’ Referral Patterns
informal, highly competetive network of physicians for referrals
The Seeds of New Medical Care Structures
Contract Doctors
Fraternal organizations or remote companies
Multispecialty Group Practice
sallaried physicians work together
group collects on a fee-for-service basis (Mayo Clinic)
AMA did not like this idea--wanted physician autonomy
Community Health Centers
preventetive medicine
rural nursing gave way to nurses working in hosptials in the 1960s
neighborhood health centers helped work with the community to prevent hospitalization--came out of favor in the 1980s
Prepaid Group Practice & HMOs
Kaiser and Group Health Cooperative of Puget Sound both offered specific services for pre-payement, both strove to integrate the providers and the hosptials within the insurance system
HMO term made up by the Nixon administration to seperate it from the pre-paid cooperatives
First-Geneartion HMOs: The Kaiser-Permanente Medical Care Program
three interlocking administrative units: Kaiser Foundation Health Plan (financing and enrollment), Kaiser Foundation Hospitals Corporation(owns the hospitals), and the Permenente Medical Group (physician organziation)
physicians salaried, hosptials on a global budget
Second-Generation HMOs: Independent Practice Associations
1954 San Joaquin Foundation for Medical Care--discounted reviewed fee-for-service capitated HMO desigend to compete with Kaiser-Permanente
1973 legitimization of HMOs by Nixon
Will the HMO Era Bring Primary Care-Based Regionalized Medical Care
people like the individual care of fee-for-service