5 Myths and Facts about HMOs in Nigeria.
People generally assume HMOs are big businesses that put profits before patients but is this true? Or is it a misconception by those who don’t know much about how HMOs work?
Here are some facts to dispel common myths about HMOs.
Myth 1: HMOs enjoy denying care in order to cut costs.
Fact: the essence of managed care is arranging appropriate medical care in a cost-effective setting. Denying available benefits for appropriate and necessary care makes no sense.
This is because such denials would delay needed treatment, thereby increasing the risk that an illness would worsen and become much more expensive to treat. denials would also create extraordinary customer dissatisfaction, which no serious HMO would tolerate.
Rather, by using scientific medical information, HMOs work with physicians to reach a consensus on what services are medically appropriate & then assure that these services are available to members, usually through their network of hospitals and other providers.
Myth 2: HMOs are only interested in healthy members.
Fact: HMO plans seek to keep healthy people well. However, they also cover chronic conditions such as diabetes and hypertension. In fact, HMOs have been pioneers in developing specialized programs for the chronically ill which combine early diagnosis, proper monitoring, patient education and aggressive treatment.
By educating chronically ill patients on ways to control their condition and reduce the need for emergency hospitalizations, HMOs help to improve their members’ quality of life.
Myth 3: HMOs are more focused on making money than on keeping people healthy.
Fact: Like any business, HMOs are obligated to seek a fair return on investment. However, the way to profitability in healthcare is by effectively meeting customer needs. That means an array of programs designed to meet their members’ needs. For example, many HMOs have call centres staffed by trained nurses, maternity programs to assist new mothers, etc. Leading HMOs also monitor their providers to ensure they are treating their members well.
Myth 4: HMOs don’t let you choose your hospital.
Fact: With most HMOs, you’ll be able to choose. When your health insurance goes into effect, you’ll need to choose your primary care provider from within the HMO network. If you change your mind later, you can switch.
Myth 5: Patient care under HMOs is inferior to traditional insurance.
Fact: Not true, the quality of care in HMOs isn’t inferior to that provided to patients enrolled in indemnity insurance plans. The notion that the quality of care in HMOs is systematically worse is unfounded.
In summary, managed care in Nigeria isn’t perfect. But much of the criticism is misplaced. HMOs wouldn’t stay in business for very long if they weren’t delivering what employers and employees are demanding – improved quality of care, affordable costs, etc.
PS: HMOs = Health Maintenance Organisations
Credit: Avon Healthcare