The idea was to cut cost by various methods: requiring pre-certification before apatient is admitted to the hospital, using strict admission criteria; discouragingpatients from going to emergency rooms or seeing specialists; mandatingphysicians to prescribe and use the cheaper generic medications; forcing physiciansto use less expensive, and less, diagnostic tests; requiring physicians to dischargetheir hospital patients sooner, sometimes too soon; decreasing reimbursement tohospitals and physicians by 30 to 50%; refusing to cover and pay physicians andhospitals for certain medical care, illnesses or hospitalization that the companydeems "not covered," etc. It also instituted dozens of "strict and somewhat punitive"rules, criteria, and policies for physicians and hospitals to follow in providinghealthcare to patients "if they want to participate in the HMO and be paid at all."
Did HMO help the people?
No. As a matter of fact, the quality of healthcare has suffered and access to caremore difficult. Patients feel they have lost their freedom of choice of familyphysicians and specialists. The wait in the doctor’s office is much longer, and thecare much less personalized, since HMO doctors are salaried and are assigned toomany patients. Since they get paid the same whether they see 20 or 40 patientsanyway, the incentive to do their best is not the greatest. More sophisticated tests(CT Scan, MRI, Heart Angiogram, etc.) are considered "too expensive" by HMOs,whose main concern appears to be their financial bottom line and not the quality of medical care. In subtle ways, they discourage the use of what they consider "toocostly tests or medications," handicapping the physician in his service to hispatients. Unfortunately, it takes years before people find out the painful truth andcomplain about it, and another 2 decades or so to have the mistake corrected thrulegislature, as in the case of this American experiment with HMO.
Has HMO invaded the Philippines?
Unfortunately, yes, but fortunately HMO in the Philippines is still in its buddingstage. The traditional healthcare delivery system is still the major force in thecountry, and the people and our medical care are the better for it. Hopefully, theFilipinos, our political leaders, our businesses, hospitals and physicians can uniteand prevent the growth and catastrophic onslaught of US-style HMOs on thehealthcare system in the Philippines. HMO has adversely affected medical care andhealthcare delivery in the United States. The US Congress is now re-discussing theHMO issues and exposing the adverse effects of HMO and the resulting deteriorationof the healthcare delivery in the country.Let that painful and inhumane national "experiment" in America be a warning for usFilipinos to be vigilant to protect and preserve our most fundamental privileges:quality medical care, easy access, and the freedom of choice, at a most affordablecost. HMO, as it stands today, is more of a health menace organization and, if allowed to take root and flourish in the Philippines, will clearly be hazardous to thehealth and well-being of our country and its people.Since the United States experience with HMO has been a catastrophe as theAmericans have found out, and most eager to throw it out, wouldn’t it be stupid forus, Filipinos, to adopt it for our country.