y costs (Evans).This leads to the question, if people are so unhappy with the cost and quality of HMOs, why are they continuing to sign up in record numbers? It should be understood that, first and foremost, an HMO is not a public service organization. HMOs are in business to make money, and the more people they can enroll, the greater the profit. When the general public or their employers go shopping for a health care alternative, they are often unaware that they may become victims of a slick marketing campaign on the part of the HMO. One such glossy, potential patient-friendly brochure, as quoted inConsumers' Research Magazine, read, "No Medicare deductibles, affordable copayments, and unlimited hospital stays when medically necessary. Emergency care anywhere in the world. Virtually no claim forms to file.... Routine physical exams (preventive health services). Prescription drug discounts, dental coverage, vision coverage" (Evans). As we all know, if it sounds too good to be true, it IS NOT TRUE. Language in HMO plans is purposely ambiguous and is intentionally subject to broad interpretation. The flyers frequently mention "unlimited hospital stays," but never clearly define what these stays are for (Evans PG). Then, of course, there is also the equally vague qualifier, for treatments that are "medically necessary" (Evans PG). What does this mean? What may constitute a medical necessity for the patient may not for the HMO. Because the HMO is the provider and paying the medical bill, it is responsible for making a determination as to medical necessity, not the patient or his physician. The patient is primarily concerned with his or her medical condition, whereas the HMOs main focus is the costs which will be incurred in treating this ailment.However, what the HMOs advertisements do not tell us is that inefficiency has always categorized HMOs. In 1995, it was reported, that over 25% of HMO members said they waited more tha...
