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Under the social HMO model, a single provider organization assumes responsibility for a full range of ambulatory, acute inpatient, rehabilitative, nursing home, home health, and personal care services under a prospectively determined fixed budget. .
Because the social HMO consolidates the system at all levels-provider, population, finance, and risk-it have the potential to be a powerful intervention. Its developers believe that consolidation of services will make it possible to redefine and coordinate provider roles and relationships and to do so without some of the regulatory and reimbursement constraints that currently shape such relationships. The membership concept gives provider's authority to manage care of individuals across the full spectrum of services. The balance membership has an important financial function in tar it should create an insurance mechanism for long-term care thought the premium. Prepayment and fund's pooling should remove financial barriers to innovation. Finally, assigning financial risk to the social HMO should make cost-effectiveness an important criterion for decision making. .
WORK PLACE ISSUES.
Health care makes money three ways: though direct medical care expenses, though illness or injury-related absences and business interruption, and through productivity lost when employees are not feeling there best. Recent studies show all three areas can be managed. That is a win- win situation: Active management of health increases business profitability and provides a valued benefit to employees. .
Traditionally, employers have provided for medical of injury or illness, after it accrued, though open-ended insurance benefits. This cost in the past has been significant. Since the mid-1970s, businesses have sustained persistent increases in their health care budget. Payment for health care or insurance, which was 1 percent in the 1950s, is now 5 percent of the payroll.