HMOs were started in 1973 with the hope of providing good health care at less cost. Unfortunately, unless a patients know how to navigate the HMO in which they have signed up for care, they may be in for some bad surprises. The patients who are assertive and who will not accept less than the best care will think their HMO care is fine. Most patients still have a healthy respect or fear of medical personnel and don't like to be thought of as difficult patients. However, the "squeaky wheel does get the grease." This is certainly true of medicine in general and HMOs in particular. Some are good and some are not. My biggest concern with HMOs is that they do not like to pay for outside specialists, even if they don't have the needed specialist on their staff. My other great concern is that HMOs allow nurse practitioners to take charge of patients without working along with an M.D. and even write prescriptions for patients. If you compare the few years of training a nurse practitioner has with the many years of education and training an M.D. has, this can be a major problem.
If a patient needs to see a specialist outside the HMO it is possible to file a first and even a second level appeal. This does take a great deal of time and energy, but the HMO rules should state how this can be done. When I was seeing patients in the Bay area with neuromuscular disorders from all over the U. S. I was asked to see these patients from several of the Kaisers facilities in the Bay area. I did this for several years until three new neurologists were hired. The neurologists all had good neurology training, but no special training in neuromuscular disorders, as I had had in the U.S. and England. Kaiser has some excellent doctors, but also some who are not, just like all medical facilities. However, if you allow a nurse practitioner to take charge of your medical care without consultation with an M.D., there could be some real problems.