HMO = Health Maintenance Organization:
HMO is a health insurance model. The policyholder is required to consult a certain physician
practising in a HMO centre, if he falls ill. This doctor
is called a "gatekeeper".
Emergencies are exceptions to this rule.
The HMO doctor is paid a flat monthly rate for all treatment his registered patients
might need. This flat rate covers all costs for treatment provided either by himself,
by specialists or during a hospital stay.
The gatekeeper principle enables the HMO doctor to coordinate his patients' treatment.
The flat rate forces him to restrict treatment to what his patient needs. Thus, superfluous
services are no longer lucrative. HMO premiums are therefore up to 25% lower than standard basic
health insurance for the same extent of benefits.
Emergencies of HMO policyholders:
HMO policyholders must always consult their HMO doctor first. Should she/he not be available
or if the patient is away from her/his place of residence or work, she/he must seek out the nearest
available emergency physician. After the emergency treatment, the HMO policyholder must
contact his HMO physician to discuss further procedures.
Bei Notfällen wendet sich der HMO-Versicherte immer zuerst an
seinen HMO-Arzt. Ist dieser nicht zu erreichen oder befindet sich der Versicherte nicht an seinem
Wohn- oder Arbeitsort, so wendet er sich
umgehend an den nächsten erreichbaren Notfallarzt. Nach der notfallmässigen Behandlung nimmt der
Versicherte mit seinem HMO-Arzt Kontakt auf
und bespricht sich mit ihm über das weitere Vorgehen.
You will find a list of all HMO practices here. |
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