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HMOs and Managed Care


An HMO is a prepaid health plan delivering comprehensive care to members through designated providers. Almost 30 percent of all persons in the United States are enrolled in HMOs .

Enrollment in HMOs totaled 80 million persons or 28 percent of the U.S. population in 2001. HMO enrollment varied from 21 -22 percent in the Midwest and South to 35 percent in the Northeast and 41 percent in the West. HMO enrollment increased steadily through 1999 but declined by nearly 2 million between 1999 and 2001.The number of HMO plans decreased by 16 percent, to 541 plans during these 2 years.

In 2001 the percent of the population enrolled in HMOs varied among the States, from 0 in Alaska to 44 percent in Massachusetts and 53 percent in California. Other States with 38 percent or more of the population enrolled in HMOs in 2001 included New Hampshire, Connecticut, and Maryland.

In 2000, 38 percent of children had health insurance coverage through a private, Medicaid, or Medicare HMO compared with about one-third of adults 18 -64 years of age and one-quarter of the elderly. Nine percent of children (12 percent of those under 6 years of age) were in a Medicaid HMO compared with less than 3 percent of nonelderly adults. Fifteen percent of the elderly were in a Medicare HMO and 13 percent in a private HMO.

The proportion of the elderly population enrolled in Medicare HMOs in 2000 ranged from 8 percent in the Midwest to 31 percent in the West.

Excerpt from National Center for Health Statisitcs, Health, United States, 2002

 

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  • Patients Need a Real Bill of Rights: The Supreme Court on Monday struck another blow against patients' rights in denying citizens the right to sue HMOs for damages if they refuse to cover medically necessary treatments. (Center for American Progress: June 22, 2004)
  • Remember the Patients' Bill of Rights?: Through the second half of the 1990s and into the Bush administration's early months, it occupied political center stage. (Center for American Progress: May 5, 2004)
  • Covering Managed Care (Columbia Journalism Review: March/April, 1999)

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