Originally Posted by FinanceGeek
With respect to Kaiser and other HMOs it has always struck me as irrational that people choose them over PPO arrangements since they are MOST likely to deny you (or lack the ability to provide) the catastrophic and expensive high tech services that are the whole raison d'etat of health insurance. I'm sure they do great with soccer injuries, perhaps better than other models, but they have an enormous incentive towards cost containment that leads to a large number of scary incentives contrary to my health and welfare.
The HMO model is not perfect, BUT as someone who's wife used to work for Kaiser (as an RN), the one thing they did try very hard to do, was keep you healthy...the healthier you were, they less they saw you, the more money they made....on the other hand, after Kaiser left Massachusetts, the DW stayed at the same doctors office (which became independent), and the modus operandi was to tell people they needed to come in to be seen by the doctor, no matter what the complaint on the phone was. The logic being of course, the only time the doctors made money, was when they saw patients...and the sicker they were, the more money they made...and the more tests they ordered the more money they made, and if the patient stayed sick for years, even more money was made...etc etc.
Big turning point for profitability for this practice was when they purchased a few sigmoid machines to do colonoscopies instead of sending them to a specialist...apparently they are very profitable...so now all the patients are taking it up the @ss and the doctors make even more money...