What is the primary function of a health maintenance organization (HMO)?

The primary function of a health maintenance organization (HMO) is to coordinate health services and provide preventive care for enrolled members. HMOs are designed around a managed care model that emphasizes wellness and preventive measures, encouraging members to seek regular check-ups and screenings. This proactive approach helps in early detection of health issues, reduces the cost of healthcare, and fosters a healthier population.

Members of an HMO typically select a primary care physician (PCP) who acts as a gatekeeper for their healthcare needs. This means that the PCP must provide referrals for specialist services, which ensures that care is managed in a coordinated manner. By promoting preventive care and streamlined service delivery, HMOs aim to keep their members healthy and reduce the necessity for more expensive emergency care or treatments later on.

The structure of the HMO leads it to focus on managing care rather than allowing open access to any healthcare provider or only providing emergency services. Additionally, while HMOs may have limitations on coverage for out-of-state travel, their primary mission centers around the health coordination and preventive aspect for their enrolled members.