Quality Improvement: Healthcare Options

Subject: Nursing
Pages: 4
Words: 899
Reading time:
3 min
Study level: College

In nursing field, quality improvement involves monitoring of the care procedures results using the available data. It also involves the use of advanced techniques to design and test changes that will continuously increase the quality and safety of heath care system. The main purpose of improving the quality of health care is to sustain what is good in the medical care system while emphasizing on the areas that require improvement (Agency for Healthcare Research and Quality, 2002, p.1).

HMO is a healthcare insurance plan that gives the employers a method or way to cater for the health needs of their employees with minimized costs by discussing or negotiating with specific health care providers, clinics and hospitals. Moreover, the HMO offers treatment as well. The participants in the HMO decision making include health care providers who are doctors, hospitals and insurers. HMO offer health treatment on prepaid terms, in spite of how much health care is required in a certain month.

HMO members always obtain health services like treatment from health care providers and health facilities that belong to HMO, though sometimes they may receive medical care from somewhere else. It is a requirement for every HMO member to choose their own health care providers who they will always contact in case of any health care needs. This kind of a health care provider is known as a primary health doctor. Consultation from the primary health doctor is necessary before one can see a specialist. Therefore, due to this system, HMO costs are higher when compared to other insurance plans (Health Insurance, n.d, par. 1).

HMO advantages include low expenses since HMO members pay their monthly fee on fixed terms. HMO also advices and encourages its members to seek for treatment earlier before the health conditions worsens hence they emphasize mostly on preventive care and wellness. In addition, HMOs do not have a limitation on someone’s lifetime benefits. However, there are some disadvantages of HMO, complications if the primary health doctor does not refer one to a good specialist. Moreover, the HMO does not cater for non-emergency health care given by a non-HMO doctor or physician (Health Insurance, n.d, par. 2).

PPO comprises of health care providers like doctors, nurse and hospitals, which offer health services to specific people. They get their funding from insurance companies, employers or from other organizations. PPO health care providers offer health services to the employees, policyholders or members of the supporting company (s) at subsidized price and organize control programs to assist in reduction of the health care cost. The PPO members make payment during service provision time instead of paying earlier. In some situations, the health care provider may give the medical bill directly to the insurance company to settle the payment.

The insurer later pays the settled amount directly to the physician. There are two main advantages associated with PPO that include freedom to choose the health care provider and limited costs paid from one’s pocket like co-payments. However, there are two disadvantages of PPO, coverage for treatment given by non-PPO doctors is less and there is a lot of paperwork and expenses when compared to HMO.

Finally, there is the PHO, which receive its sponsorship from the District Health Boards (DHB) or government in order to offer important medical care services to the individuals who are part of or have enrolled with PHO. PHO gathers together nurses, doctors and other health care providers in the community to offer health services to the people or populations of PHO. The services offered by the PHO are provision of health care and treatment to sick people, assisting people to be healthy and reaching out to groups of people with poor health or are not part of primary health care. Payment to PHO is in different methods like subsidized fee for service and capitation. This form of flat rates paid to the physicians affects the quality of health care given to the patients (Denise, 1996, p.2).

Bearing in mind the services, advantages and disadvantages in the above-mentioned insurance plans, one would benefit more if she or he enrolls in HMO. This is because there are several people who participate in HMO business arrangement. Moreover, the costs or expenses are less and there is no limitation on lifetime benefits.

In the United States, most of the people have health insurance through their parent’s, spouse’s or own employment. However, there are those who are not yet insured and are most likely to be poor, unemployed or earn low income. Therefore, all that is required is an approach that will assist all Americans to gain access to health insurance while encouraging them to embrace healthy lifestyles. This is captured in the current health reform that President Barrack Obama is about to sign, hence, there will be a solution in the healthcare to those who are uninsured. The current health reform gives all Americans an opportunity to access the health insurance. Therefore, if the United State health reform goes through, no one will have to worry about health insurance coverage.

Reference list

Agency for Healthcare Research and Quality, (2002). Improving Health Care Quality: Agency for Healthcare Research and Quality. Web.

Denise, G. (1996). Developing an incentive system for PHO physicians. Healthcare Financial Management. Web.

Health Insurance, (n.d). HMOs, PPO & POS Plans. Web.