The Evolution of Health Maintenance Organizations

This thesis focuses on the development of Health Maintenance Organizations (HMOs) in the twentieth century. While the origins of the movement in the 1930s and 1940s are discussed, emphasis is also placed on the early 1970s and the 1990s, when HMOs proliferated at the national level, altering the spectrum of healthcare provider models in the United States. By 1999, the number of HMO enrollees in the U.S. had grown to its peak of approximately 80 million. In addition to its historical background, the overall philosophy of HMOs is studied and subsequent flaws in both HMO structure and function are examined. This last part focuses on the ethical and moral questions of HMO patient care. In examining the evolution of HMOs, cases of patient neglect and treatment shortcomings are evaluated and found to be the result of a business model designed for treating patient populations with an economically efficient remedy, rather than a treatment that is the most medically effective.