Six Shocking Facts About HMO, Retainership.
Many corporate organizations are spoiled with HMO and retainership choices. While some may stick with HMO, others may want to hold on to retainership.
Why is this a cause of concern?
The truth is both models of getting healthcare involves payment but which is better?
Before we get into the distinguishing factors that make each unique, let’s first understand their meaning.
HMO stands for Health Management Organisation. This involves a pre-payment plan for various health care services. It ranges from health insurance plans, pharmaceutical care, medical care and routine health checks. The HMO allows an array of hospitals and give several options in cost of subscription and access to care. Since HMO involves health insurance, the pool of funds makes healthcare very affordable.
A retainership policy ensures that an organization, person or family pays a huge deposit to a hospital for treatment. Whether or not the payment supersedes health care delivery, the money paid remains the same. Also, payments are made after the treatment, not before it.
While each model involves a certain payment plan, it is important to understand its uniqueness. The purpose of this article is to guide everyone in making the right decision.
Each HMO are assigned to various hospitals in different areas of the country. These are classified as the Health Care Providers often labelled the HCPs.
For an enrollee or a subscriber, they can access healthcare with any HCP within the bandwidth of their HMO. In a simpler term, there is always a hospital closest to their residence for them to access care.
Also, in a situation where they fall into any health crisis away from home, they can still access care. As long as the hospital is within the bandwidth of the HMO.
This is not the case with retainership.
Unlike the HMO, retainership restricts patients to one hospital for care. This is the hospital that the organization, family or person goes to for care and pays a certain amount at the end of the year. In a case of emergency, the patient is forced to pay out of pocket to avoid a health crisis.
Subscribers or enrollees pay a premium to HMOs which covers access to care for up to six months and one year.
These premium grants enrollees access to care after payment has been made. It is usually a fixed rate. However, this is largely not the same case with retainership.
A retainership plan is mostly post-paid. Patients or organizations pay the hospital yearly for treatments received. The cost of medical treatment is not fixed due to the kind of healthcare delivered. Also, the hospital can capitalize on the flexibility and manipulate the bills for the year.
People often key into HMO because healthcare delivery is affordable. As noted in the previous point, premiums are fixed and can only be increased upon renewal. This is usually for wider coverage of healthcare delivery or due to regulations by the National Health Insurance Scheme.
Also, the HMO involves a pool of funds and is mostly a pool of chance. What this simply suggests is that it isn’t everyone who subscribes to a health insurance plan that falls into a health crisis. So, some patients are allowed to access quality care due to this merit.
On the other hand, the state of affordability of retainership remains an assumption. This is because there is no regulatory body overseeing the cost of delivery. This is also, pay as you use. For serious health emergencies, there is no contingency fund to cover one’s treatment.
HMO audits and manages the healthcare of their enrollees. If the HCP fails to give appropriate care to a patient, the situation can be investigated. The HMO also selects the best hospital to administer care to their enrollees.
However, with retainership hospitals cannot be audited and care is not managed. There is usually no middleman to handle any crisis from the hospital.