We'd call it a maintenance contract.
Yes, and that's why the "M" in HMO stands for, well, you know.
There are some inherent conflicts of interest in HMOs, basically the capitation plan takes a set fee from everyone, and you might use far more than you paid for, or far less. Whatever is left over, the doctors get to keep, so there's an incentive to do less and keep more, in which case the patients suffer.
With regular health insurance, the incentive is to do too much, in which case, the premiums go up or the insurance company goes broke.
I don't think Kaiser has ever run the risk of going broke.
Oddly, because the premiums are far cheaper than Blue Cross, Blue Shield, but the co-pays are also far cheaper. Could be that paying for preventive maintenance actually pays off.
I pay $10 for a regular visit (even for annual physical), $20 for a specialist, nothing for a hospital visit or surgery, nothing for x-ray, ultrasound, or lab, $10-$20 for generic drugs, $40 for drugs still under patent. No deductible, just co-pay. |
