The HMO had to manage its services and finances from a fixed amount of money paid per person under coverage, termed “capitation.” The financial incentive under this model was to limit care as much as possible, and many abuses of both health and mental health care occurred during this period.
These problems, coupled with more restricted access to care, created much consumer dissatisfaction and distrust of the health care system. Also, despite its restricted policies, the HMO was ineffective at containing costs. Partly as a consequence, the Preferred Provider Organization (PPO), in which consumers could choose and go to specialists without authorization from their primary physician, became much more prevalent, rising in market share from 35% in 1998 to more than 60% today.
As the HMO model began acceding more to the PPO model, and as medical records increasingly began to be shared online, the Health Information Protection and Accountability Act (HIPAA) was introduced in 1996 to address the privacy and confidentiality of medical records.
Despite this evolution of health care legislation, costs continued rising at alarming rates, consuming 16% of GDP by 2009. Increasing numbers of people were uninsured, and many bankruptcies occurred as a result of uncovered health crises. Insurers were denying care for pre-existing conditions, dropping high risk cases from coverage, and too often denying care to the most vulnerable members of the society. This led to the introduction of the Affordable Care Act by the Obama administration.
The Affordable Care Act is an ambitious attempt to address many elements of our nation’s health care problems. Extending health and mental health care to more people is one of its primary goals, but it has numerous other goals and intentions for the public good. We will address these in the next blog.
An exceptionally good source of information on the Affordable Care Act may be found on a DVD published by Howard Baumgarten, LPC, a therapist and health
care consultant residing in the Denver
area (go to SmartPracticeCentral.com to purchase).
Westside Behavioral Care in Denver, CO,
is providing this series of blog posts on Obamacare as a public service.