health maintenance organization


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Related to health maintenance organization: preferred provider organization, Health Maintenance Organization Act of 1973

health

 [helth]
a relative state in which one is able to function well physically, mentally, socially, and spiritually in order to express the full range of one's unique potentialities within the environment in which one is living. In the words of René Dubos, “health is primarily a measure of each person's ability to do and become what he wants to become.” 

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.
A common concept of health as a continuum ranging from optimal wellness at one end to illness culminating in death at the other end.
allied health see allied health.
health education.
1. in the nursing interventions classification, a nursing intervention defined as developing and providing instruction and learning experiences to facilitate voluntary adaptation of behavior conducive to health in individuals, families, groups, or communities.
2. See Window on Health Education.
health as expanding consciousness a conceptual model of nursing formulated by Margaret A. newman which offers a paradigm based on the view of health as the undivided wholeness of the person in interaction with the environment. The four key concepts of her model are consciousness, movement, space, and time. Consciousness is defined as the informational capacity of the human system, or the capacity of the system to interact with the environment. Movement is the manifestation of consciousness, viewed as waves of energy and energy transformation in the space and time of a person's life.

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.
health care system an organized plan of health services. The term usually is used to refer to the system or program by which health care is made available to the population and financed by government, private enterprise, or both. In a larger sense, the elements of a health care system embrace the following: (1) personal health care services for individuals and families, available at hospitals, clinics, neighborhood centers, and similar agencies, in physicians' offices, and in the clients' own homes; (2) the public health services needed to maintain a healthy environment, such as control of water and food supplies, regulation of drugs, and safety regulations intended to protect a given population; (3) teaching and research activities related to the prevention, detection, and treatment of disease; and (4) third party (health insurance) coverage of system services.

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.
holistic health a system of preventive care that takes into account the whole individual, one's own responsibility for one's well-being, and the total influences—social, psychological, environmental—that affect health, including nutrition, exercise, and mental relaxation.
health Insurance Portability and Accountability Act an act of Congress, passed in 1996, that affords certain protections to persons covered by health care plans, including continuity of coverage when changing jobs, standards for electronic health care transactions, and privacy safeguards for individually identifiable patient information.
health maintenance organization (HMO) any of a variety of health care delivery systems with structures ranging from group practice through independent practice models or independent practice associations (IPAs). They provide alternatives to the fee-for-service private practice of medicine and other allied health professions. Although the type of organizational pattern, membership, and ownership of the organization may vary among HMOs, all have the major goal of allowing for investment in and incentives to use a prepaid, organized, comprehensive health care system that serves a defined population. The enrolled population enters into a contract with the organization, agreeing to pay, or have paid on their behalf, a fixed sum, in return for which the HMO makes available the health care personnel, facilities, and services that the population may require. The services are available on a 24-hour-a-day, 7-day-a- week basis. Some HMOs may provide directly the entire range of health services, including rehabilitation, dental, and mental health care. Others may agree to provide directly or arrange to pay only for physicians' services, in-hospital care, and outpatient emergency and preventive medical services. The kinds of services available are stipulated in the contract between the organization and its enrolled population. The emphasis of a health maintenance organization is on preventive rather than crisis-oriented medical care.
public health see public health.
health seeking behaviors a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as a state in which a person in stable health is actively seeking ways to alter his or her personal habits or environment in order to move toward a higher level of health. “Stable health” is defined as the achieving of age-appropriate illness prevention measures, with reporting of good or excellent health, and signs or symptoms of disease, when present, being controlled.
sexual health see sexual health.

organization

 [or″gah-nĭ-za´shun]
1. the process of organizing or being organized.
2. an organized body, group, or structure.
3. the replacement of blood clots by fibrous tissue.
comprehensive health organization (CHO) a nonprofit health care agency in Canada, formed jointly by representatives of the community and of health care providers. The aim is to provide a variety of health promotion and treatment services and to unify different elements of health care for a defined member population.
health maintenance organization see health maintenance organization.
professional review organization (PRO) a program on multiple governmental levels (local, state, and federal) that regulates the quality and cost of federally funded medical care. See also Professional Standards Review Organization.
Professional Standards Review organization (PSRO) see Professional Standards Review Organization.

health main·te·nance or·ga·ni·za·tion (HMO),

a comprehensive prepaid system of health care intended to have emphasis on the prevention and early detection of disease, and continuity of care; often used synonymously with "managed care plan."

health maintenance organization

/health main·te·nance or·ga·ni·za·tion/ (HMO) a broad term encompassing a variety of health care delivery systems utilizing group practice and providing alternatives to the fee-for-service private practice of medicine and allied health professions.

health maintenance organization

n.
An HMO.

health maintenance organization (HMO)

a type of group health care practice that provides basic and supplemental health maintenance and treatment services to voluntary enrollees who prepay a fixed periodic fee that is set without regard to the amount or kind of services received. In addition to diagnostic and treatment services, including hospitalization and surgery, an HMO often offers supplemental services, such as dental, mental, and eye care, and prescription drugs. Federal financial support for the establishment of HMOs was provided under Title XIII of the 1973 U.S. Public Health Service Act.

health maintenance organization

See HMO.

health main·te·nance or·gan·i·za·tion

(HMO) (helth mān'tĕn-ăns ōr'găn-ī-zā'shŭn)
A comprehensive prepaid system of managed health care with emphasis on the prevention and early detection of disease, and continuity of care. HMOs may be nonprofit or profit-making ventures; along with preferred provider organizations (PPOs) and other managed care plans, they have begun to dominate the health care market. HMOs generally offer a package of services; however, the choice of physician is frequently limited to those participating in the HMO.
See also: managed care, preferred provider organization

health maintenance organization,

n corporation formed to provide health care, often financed by the employer and employee insurance premium payments. Participating physicians, clinic, and hospital staff provide prevention and treatment to enrolled members and their families.

health main·te·nance or·gan·i·za·tion

(HMO) (helth mān'tĕn-ăns ōr'găn-ī-zā'shŭn)
Comprehensive prepaid system of health care intended to emphasize prevention and early detection of disease and continuity of care.
References in periodicals archive ?
For example, reacting to complaints that some health maintenance organizations exclude or expel doctors for ordering tests or consultations the health plans deem unnecessary, half a dozen states - including Illinois and Georgia - have required them to include any physician who has the appropriate credentials.
6 million members primarily through the operation of health maintenance organizations and preferred provider organizations.
This is the only source that provides you with all the facts on more than 1,300 Health Maintenance Organizations, Preferred Provider Organizations and Affiliated companies.
In 1992, Antelope Valley Hospital paid Lancaster Community Hospital $250,000 to drop a 5-year-old antitrust lawsuit alleging AVH engaged in unfair competition by requiring health maintenance organizations and insurance companies to use AVH for all members if any wanted obstetrics services.
Qualified (q) Rating Modifiers may be assigned to Health Maintenance Organizations (HMOs), Canadian insurers and UK insurers that meet the minimum size and operating experience requirements for a Best's Rating but do not subscribe to our interactive rating process.
To stave off continued poor earnings, health maintenance organizations have begun raising rates and cutting costs.
The health maintenance organizations have been upgraded between one to three rating levels to reflect increased capitalization, stable earnings, and greater financial flexibility throughout the Aetna organization.
Qualified Ratings assigned to Health Maintenance Organizations (HMOs), Canadian insurers and U.
It includes 329 health maintenance organizations and other managed care plans, which voluntarily supplied information on more than 50 measures.
Advocates for children, the elderly and the disabled worry that states will cut services, reduce coverage of fast-growing benefits like prescription drugs or use cheap, low-quality nursing homes and health maintenance organizations.
The American Association of Health Plans, the leading trade group for health maintenance organizations and other managed care plans, said its members ``do not and should not require outpatient care for removal of a breast.
Nationally, more than 45 million people are enrolled in health maintenance organizations.

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