THE HEALTH INSURANCE ALTERNATIVE: A Complete Guide to Health Maintenance Organizations

The case for health maintenance organization (HMO) membership--straightforwardly put. Thomas Mayer is a practicing physician at a midwestern HMO; Gloria Mayer is a nurse, educator, and author (2001 Hints for Working Mothers); together, they present a strong argument for the superiority of HMOs over traditional insurance coverage. In an HMO system, families and individuals pay one set fee per year, in return for which they receive total health care: visits to physicians, nutritionists, physical therapists, and others; any hospitalization; and (usually) related services such as dentistry and social work. Though the care is regularly provided by the personnel of the HMO and affiliated institutions, HMO membership extends to cover exigencies away from home. The Mayers give a thorough account of the history and structure of HMOs; they compare HMO coverage with traditional insurance--finding HMOs far ahead (lower costs, greater benefits); they describe HMO personnel and their roles (alternative providers, such as nurse practitioners and midwives, are more prevalent than in traditional practice); and they offer detailed advice on using HMO membership to the fullest benefit. Since the disadvantages of joining an HMO--severing ties with previous physicians, possible long waits for routine check-ups--are disposed of quickly and simply, the pro-HMO case carries considerable weight. Partisan or not: a solid guide for those contemplating or making the switch.