Frequently Asked Questions

Frequently Asked Questions

What are the differences between an HMO, an EPO, and a PPO?

A Health Maintenance Organization (HMO) is a prepaid medical group practice plan that provides a predetermined medical care benefit package. HMOs are both insurers and providers of health care. An Exclusive Provider Organization (EPO) is similar to an HMO, but it offers greater flexibility for employers to create benefits packages specific to their company’s needs. A Preferred Provider Organization (PPO) is a group of hospitals and physicians who contract on a fee-for-service basis with employers, insurance plans, or other third-party administrators.

Why is it so costly to maintain a health care system?

There are numerous costs involved in meeting requirements and delivering health care. These costs can be grouped into four large categories:

* Technology and supplies (equipment and supplies)

* Facilities (physical buildings, land, and cost of maintaining them)

* Personnel (labor costs)

* Financing (interest, accounts payable, accounts receivable)

Why are there so many complaints about the current health care delivery system?

The health care delivery system has undergone tremendous change since the fee-for-service approach was primarily phased out. The costs of health care and how they are paid have resulted in many attempts to improve the efficiency and decrease the costs. The model of care has gone from a problem-oriented approach (the patient had a problem and resources were used, regardless of the cost to try to solve the problem) to a resource-oriented approach (what can be done with the resources available, and how costs can be cut). Major changes create confusion and dissatisfaction, especially when it is perceived that access to health care has diminished and greater delays are encountered in care.