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Health maintenance organizations (HMOs) are becoming increasingly dependent on health management information systems (HMISs) for their effective functioning. Because of this reliance, HMOs must use disaster recovery planning to safeguard their HMIS assets from natural as well as man‐made disasters. This article assesses the HMIS environment and identifies the state of practice by HMOs as it pertains to HMIS disaster preparedness.

This study examines the economic consequences of non-financial measures of performance in contracts between health maintenance organizations (HMOs) and primary care physicians (PCPs). HMOs have expanded contractual arrangements to give physicians not only financial incentives to control costs, but also to make the physicians accountable for the quality of patient care. Specifically, we examine how quality provisions in HMO–PCP contracts affect utilization (patient length of stay in the hospital), patient satisfaction, and HMO costs. Our results show that quality clauses are associated with a statistically significant increase in utilization (29 more hospital days annually per 1,000 HMO enrollees). Further, inclusion of quality clauses in PCP contracts also led to a significant increase in patient satisfaction, but no associated increase in HMO costs. Overall, these results suggest that quality clauses in PCP contracts can increase value by increasing customer satisfaction without significantly increasing cost.

This paper examines the health care experiences of older adults over a five-year period, including continuity in care, changes in health insurance coverage, and satisfaction with care.

Face-to-face interviews were conducted annually with 415 older adults (mean age = 84, range = 72–105), 100 of whom were originally health maintenance organization (HMO) subscribers and 315 of whom were receiving fee-for-service care. Several predictors of health care experiences were examined, including personal characteristics, health status and health care variables. Coverage type (HMO or fee-for-service) was the most consistent predictor. HMO subscribers were more likely than fee-for-service recipients to experience changes in insurance (both negative and positive changes) and discontinuity in physician care, although satisfaction with care did not vary among HMO and non-HMO members. Two-thirds of HMO subscribers and nearly one-third of fee-for-service recipients reported changes in insurance coverage over the five-year study period. In terms of perspectives on HMO care, the most frequently mentioned advantage of HMO care among those in HMOs was diminished costs, while fee-for-service subscribers did not believe there were any advantages to being in an HMO. Those not in HMOs viewed loss of physician choice and poor quality care as major disadvantages of HMOs. Results of this study demonstrate that older adults commonly experience changes in their health care coverage and physician care. They adapt to these changes through positive appraisals of the type of case they receive.

Tests the theory that owners (hospital, physician, insurance) of vertically integrated health maintenance organizations (HMOs) might substitute towards production of their own specialty goods. Uses data from various sources in the USA. Determines the impact of ownership on factors such as average physician ambulatory services per enrollee and average hospital days per enrollee. Concludes that policymakers need to encourage the development of standard publicly available quality measures to intensify competition and eliminate excess profits accruing to provider‐owners who substitute towards production of their own goods.

Perhaps the most remarkable event in the US medical market in the last ten years has been the astonishing growth of the new kinds of health‐care delivery systems that are collectively known as health maintenance organisations (HMOs). Indeed, they are now posing a serious threat to the conventional insurance sector which has traditionally covered most Americans. According to data collected by the US Department of Health and Human Services and the Minnesota research foundation, InterStudy, some 18.9 million people were enrolled in an HMO in June 1985, so that the 400 HMOs then in existence accounted for roughly nine per cent of the health‐care market. Today's figures are undoubtedly higher, and one New York investment company expects that ‘by 1990, 75 million people, or 30 per cent of the population, will be members of HMOs’, with the organisations achieving ‘membership expansion and revenue growth of 30–40 per cent a year’

The spiraling cost of health care is emerging as one of the country's most urgent problems and a major domestic political issue. In the 1940s, prepaid medical care provided by groups of health‐care professionals began to take hold and finally emerged as a serious prospect for cost‐effective health care with the passage of the Health Maintenance Organization Act of 1973 (42 U.S.C. 300e). Although still not widespread, interest in HMOs is growing and government incentives to private investment in such organizations should prompt inquiries to libraries from citizens groups, businesspeople, and potential customers of these services. Here is a sampling of items on the subject.

Estimates a total effects cost function using a national 1994 health maintenance organization (HMO) data set to examine and update findings related to HMO efficiency. The cost function controls for ownership characteristics (profit status and ownership), size, enrollment diversity, regional location, product diversity, model type, payment characteristics, and years of operation. While not explicitly controlling for quality or acuity, measures of plan and enrollee diversity help control for acuity and quality. Results show that most of the difference in cost efficiency between HMOs is explained by factors specific to the HMO, including efficiencies of scale and scope, lower levels of Medicare patients, and efficient levels of capital. The study also shows that for‐profits are more efficient than non‐profits because they rely less on withhold pools to control costs. Limitations of the study include weak controls for quality of care, and limited data related to payment characteristics.

In the USA, health maintenance organizations (HMOs) have pledged to control health care costs. Many patients have complained about the quality of care under the HMO regime and limits imposed on them, particularly access to care. Has quality of care been degraded under the HMO regime, resulting in an impact on patient satisfaction? There have been many studies that have compared the satisfaction of HMO patients with that of patients in the traditional fee‐for‐service payment system. The aim of this paper is to review HMO patient satisfaction.

A review of patient satisfaction under managed care arrangements with a focus on HMOs. The article describes the US history of managed care and its effect on the satisfaction of several patient categories including the general population, vulnerable patients and the elderly.

There is much information available on patient satisfaction with their insurers and most surveys indicate the lack of choice of a provider – a major source of discontent. Therefore, patient protection laws are necessary to avoid abuse.

Patients have little ability or are not willing to rely on the information available when selecting a provider. The paper discusses patient awareness regarding satisfaction surveys and how the latter can be used when patients are seeking care.

Provides a review and analysis of Medicare health maintenance organizations in the USA. The Porter model of industry structure is used. Discusses the issues of suppliers, buyers, market entry and substitutes. Indicates there is currently no intense rivalry among Medicare risk‐based HMOs. However, the Porter model reveals crucial information regarding the forces which drive industry competition. Trends in the field of managed care and Medicare financing continue to be a real challenge regarding future research.

Despite continuing debate about costs and benefits, managed care became an integral part of the health care sector during the 1990s. In this paper, we examine the organizational and practice variation in the managed care industry at two points in the 1990s using a national census of organizations operating in those years. We use a definition of managed care that captures the increased diversity within the industry while still distinguishing it from traditional indemnity, fee-for-service care. We draw on institutional theory to begin to formulate a framework for understanding why certain organizational forms and practices emerged when and where they did.