| Book Review | The Journal of American History, 93.1

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| Book Review | The Journal of American History, 93.1 | The History Cooperative

Book Review

The Rise and Fall of HMOs: An American Health Care Revolution. By Jan Gregoire Coombs. (Madison: University of Wisconsin Press, 2005. xviii, 412 pp. $35.00, ISBN 0-299-20240-2.)

First coined in the 1970s, the term "health maintenance organization" (HMO) described a fundamentally new way of paying for health care. Unlike the fee-for-service insurance system, which reimbursed clients for each instance of medical service, HMOs provided comprehensive care for a predetermined monthly payment. Rather than merely paying for medical care, the organizations that ran HMOs attempted both to evaluate policyholders' (or applicants') need for care and to influence physicians' medical decision making about what care to provide. Although only about a quarter of Americans are now enrolled in HMOs, the HMO movement has changed almost every part of the health care system. HMOs helped draw attention to heath care costs, encouraged the use of evidence-based guidelines for clinical care, and, to some extent, promoted the advantages of primary care and preventive services. HMOs were intended to slow the inexorable increase in health care costs, increase access to health care, and improve the nation's overall health. But those grand promises have not been fulfilled. What happened?

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