Explore BrainMass

The three basic types of health insurance programs

The three basic types of health insurance programs in a managed care organization are health maintenance organization (HMO) ,Preferred Provider Organization (PPO), and Point of Service Preferred Provider Organization (POS PPO).). Describe the general characteristics of each of the organizations, such as the products they supply and the restrictions and benefits they offer. Discuss the similarities and differences among the three organizations.

Solution Preview

Health Maintenance Organizations or HMO's and PPOs are similar in that they both focus on preventative care and implementing utilization management controls. Both aim to reduce healthcare costs. On the other hand, HMO's are special because they not only do this but they also deliver treatment. Most likely, your primary care physician (PCP) participates in an HMO. HMO members (or patients) do not need to pay a monthly service fee; it is prepaid. Therefore, it doesn't matter how much you spend in healthcare costs a month. This includes hospital visits (even surgeries) as well as regular check-ups. HMOs decide in advance what a particular health service will cost. HMOs ...

Solution Summary

The three basic types of health insurance programs. The general characteristics of each organization is determined.