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HMOhealth maintenance organization.
Current views of health and illness recognize health as more than the absence of disease. Realizing that humans are dynamic beings whose state of health can change from day to day or even from hour to hour, leaders in the health field suggest that it is better to think of each person as being located on a graduated scale or continuous spectrum (continuum) ranging from obvious dire illness through the absence of discernible disease to a state of optimal functioning in every aspect of one's life. High-level wellness is described as a dynamic process in which the individual is actively engaged in moving toward fulfillment of his or her potential.
Person and environment are defined as co-extensive, open energy fields. The two evolve together and move toward increasing complexity and diversity, manifested in patterns of interaction that occur along continua of time and space. Person is also defined as a specific pattern of consciousness.
Health is a process of expanding consciousness that synthesizes disease and non-disease and is recognized by patterns of person-environment interaction. An understanding of pattern is basic to an understanding of health, and involves the movement from looking at parts to looking at the whole. Pattern is defined as information that depicts the whole, and gives an understanding of the meaning of relationships.
Nursing is an integrative force within the new paradigm of health seen as the undivided wholeness of the person in interaction and as a process of evolving consciousness. The nursing process is modified by Newman and encompasses nursing diagnosis/intervention based on the unique configuration of each person-environment interaction. Intervention is broadly intepreted as the recognition and augmentation of person-environment patterns, where the nurse and the client evolve together toward expanding consciousness.
In the United States, the spectrum of health care has been defined by the Department of Health and Human Services as encompassing six levels of health care. The first level of care is preventive care, which is primarily provided by school health education courses and community and public health services.
Primary care is the usual point at which an individual enters the health care system. Its major task is the early detection and prevention of disease and the maintenance of health. This level of care also encompasses the routine care of individuals with common health problems and chronic illnesses that can be managed in the home or through periodic visits to an outpatient facility. Providers of care at the primary level include family members as well as the professionals and paraprofessionals who staff community and neighborhood health centers, hospital outpatient departments, physicians' offices, industrial health units, and school and college health units.
Secondary or acute care is concerned with emergency treatment and critical care involving intense and elaborate measures for the diagnosis and treatment of a specified range of illness or pathology. Entry into the system at this level is either by direct admission to a health care facility or by referral. Provider groups for secondary care include both acute- and long-term care hospitals and their staffs.
Tertiary care includes highly technical services for the treatment of individuals and families with complex or complicated health needs. Providers of tertiary care are health professionals who are specialists in a particular clinical area and are competent to work in such specialty agencies as psychiatric hospitals and clinics, chronic disease centers, and the highly specialized units of general hospitals; for example, a coronary care unit. Entry into the health care system at this level is gained by referral from either the primary or secondary level.
Respite care is that provided by an agency or institution for long-term care patients on a short-term basis to give the primary caretaker(s) at home a period of relief.
Restorative care comprises routine follow-up care and rehabilitation in such facilities as nursing homes, halfway houses, inpatient facilities for alcohol and drug abusers, and in the homes of patients served by home health care units of hospitals or community-based agencies.
Continuing care is provided on an ongoing basis to support those persons who are physically or mentally handicapped, elderly and suffering from a chronic and incapacitating illness, mentally retarded, or otherwise unable to cope unassisted with daily living. Such care is available in personal care homes, domiciliary homes, inpatient health facilities, nursing homes, geriatric day care centers, and various other types of facilities. See also home health care.
HMOHealth maintenance organization Managed care 1. A comprehensive health care system that provides or ensures delivery of basic and supplementary health maintenance and treatment services including inpatient and ambulatory care, in a defined geographic region to a voluntarily enrolled group of persons for a premium; the HMO requires that its enrollees use the services of designated (participating) physicians, hospitals and other providers of medical care and receive reimbursement through a predetermined, fixed periodic prepayment by or on behalf of each individual or family unit regardless of the amount of services provided; use of physician outside the HMO nework requires preapproval Pros Reduced out-of-pocket costs–ie, no or minimal deductible, no paperwork–ie, insurance forms, and a minimal copayment for each office visit to cover the paperwork handled by the HMO HMO healthcare services Hospital, physician, often prescription drug and vision care, home care, and other services HMO models Staff model, group model, independent practice association, network model. See Gatekeeper 2. An organized group of physicians paid in advance for providing health care services to a voluntary population of individuals. Cf Group model, HMO network, Independent Practice Association model, Network model, Risk HMO, Staff model.
The term HMO refers to a health care delivery system characterized by multiplicity of services (primary care physicians and specialists, laboratory, radiology, pharmacy, and hospitalization); restriction of services to subscribers and of benefits to participating health care providers, both typically confined to a specific geographic area; and an accounting system based on prepayment rather than fee-for-service. An HMO may be a nonprofit institution or a commercial enterprise. During the last quarter of the 20th century, HMOs emerged as an important alternative to traditional medical indemnity insurance plans, and largely supplanted them. HMOs have had a profound effect on every aspect of the practice of medicine-professional, scientific, social, economic, and legal. see also managed care.