December 30, 2011

by okdrsblog 4. January 2012 06:58

December 30, 2011

There exist HMO's run by private companies which are designed specifically for Medicare patients.  Their premiums, copays and deductibles may be attractively much less expensive or even non-existent. As I understand it, the company is paid a certain fixed amount of money every year to take care of  all the healthcare needs of the indiviual enrollee. If one becomes ill, unlike traditional Medicare plans, the company may deny some tests and treatments. It is obvious that besides efficiency scales, which have a definite endpoint and limit, denying interventions and diagnostic tests would be an avenue to generate revenue.

The crucial question then arises regarding what constitutes nonessential tests and treatments. How is this decided on by one insurance company?

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December 16, 2011

by okdrsblog 4. January 2012 06:57

December 16, 2011

This week’s health care news is mostly focused on ACO’s.

ACO stands for accountable care organization. This is basically an HMO that is owned by a hospital, insurance company, or a group of physicians.

The principle is to cut down on costs by rendering more efficient services.

The pit fall would be that which did in the HMO’s, namely denial of care.

Another hot topic this week is what is essential health care? In other words what is basic health care that will be the goal of universal health care for all Americans.

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