The governments of the world are looking for ways to improve efficiency, effectiveness and equity of their health care systems. Recently, primary health care has gained acceptance in the quest of achieving its aims (Besley & Gouvea, 2004). Primary health care in many nations is accessible, equitable and mostly favors the poor and the marginalized. The use of primary care physician’s increases patient satisfaction and reduces costs of health (Oxley et al., 2004). Primary health care does not have adverse effects on the quality of health care. It ensures maximum service utilization.
The health care insurance through HMO is cheap. HMO care establishes network of care providers available to members of different organizations. The HMO functions as a gatekeeper for the patient. He organizes all the appointments and refers the patient to a physician if there is need. This is very convenient for the patient and ensures minimum spending out of pocket (Felt-Lisk, 2000).
There are disadvantages associated with gatekeeper system. It makes patients leave their current physicians to go to a doctor that has association to HMO (Smith et al., 2013). This is very troubling to patients that have trust in their physicians. Most health care plans require a referral from HMO programs. This makes seeing a specialist very difficult. It is difficult to switch from one HMO physician is difficult, this makes patient to feel stuck with a physician that they do not trust and like. Another difficult situation arises when the physicians leaves the HMO program (Weinstein, 2001). This will lead to the HMO program to assign you another doctor that will create a situation where the patient will start to build a new relationship with the doctor. If a patient has a serious illness, the doctor hurries through the process and this creates loopholes for medical errors.
References
Besley, T., & Gouveia, M. (2004). Alternative systems of health care provision. Economic policy, 199-199.
Felt-Lisk, S. (2000). How HMOs structure primary care delivery. Managed care quarterly, 4(4), 96-105.
Oxley, H., MacFarlan, M., & Gerdtham, U. G. (2004). Health care reform: controlling spending and increasing efficiency (Vol. 149). Paris: OECD.
Smith, M. I., Wertheimer, A. I., & Fincham, J. E. (2013). Pharmacy and the US health care system. London: Pharmaceutical Press.
Weinstein, M. (2001). Should physicians be gatekeepers of medical resources? 27 (4), pp. 268- 274. doi:10.1136/jme.27.4.268 [Accessed: 25 Mar 2014].Bottom of Form
