On the Limits of Expanding Health Care Reform: Chronic Care in Prepaid Settings

Health Maintenance Organizations have become a favored vehicle for reform of the American health care system, while controlling costs and assuring quality. But for populations with a high prevalence of chronic disease--the elderly or the mentally ill--HMOs may fall short of meeting needs. Three stages of reform are proposed for adapting the principle of prepayment to better serve enrollees with chronic illness.