HMOs in the U.S.A. and Britain: a new prospect for health care?

Health Maintenance Organisations (HMO) are poised to become the mainstream form of health care delivery in the U.S.A. by the end of the next decade. This article charts their progress and the expectations held for them in both the U.S.A. and Britain. It is argued that HMOs are undergoing corporatization in the U.S.A., while in the U.K. they are being considered chiefly as instruments of privatisation and as a method for introducing managerial authority into the medical profession. The claims of advocates of HMOs, in terms of their competitive effects, reduced costs and enhanced quality of service, are reviewed. Although no HMOs exist in Britain, they have found support in influential quarters. The proposals and claims of the advocates of HMOs in Britain are reviewed. Although HMOs have not yet found favour with the current government, it is argued that the concept will continue to receive support and may become a component of health policy in the near future.