Organizational Structure and Professional Norms in an Alternative Health Care Setting: Physicians in Health Maintenance Organizations

摘要

The development of new organizational forms for the delivery of health and medical care in the U.S. includes health maintenance organizations (HMOs), designed to provide a set of comprehensive basic health services to a defined population for a fixed prepaid premium. As complex organizations, HMOs have the potential for limiting the autonomy of professionals working in them. This paper describes the legal requirements and organizational mechanisms under which physicians practice in HMOs and considers the potential for conflict between the organization and professional norms.On the basis of document and interview data from nine HMOs, it appears that mechanisms developed to implement the mode of physician reimbursement and legal requirements for quality assurance and member grievance procedures do not limit physician autonomy in these HMOs. Variation was observed among the three organizational models: staff, group, and independent practice association.