Final answer:
In an HMO, the person in charge of overseeing patient services is called a care manager or case manager. Their role is integral to managing healthcare costs effectively, while ensuring patient care is not compromised. HMOs operate under a capitation model, which contrasts with fee-for-service systems, and aims to reduce moral hazard and adverse selection in healthcare provision.
Step-by-step explanation:
In a Health Maintenance Organization (HMO), the individual responsible for monitoring the services provided to a patient both inside and outside the facility is known as a care manager or case manager. The care manager plays a critical role in ensuring patients receive appropriate, timely, and cost-effective healthcare services. HMOs operate under a capitation payment model where medical care providers are reimbursed a fixed amount per enrolled member, which contrasts with the traditional fee-for-service model where reimbursement is based on the quantity and cost of services provided.
Due to this payment structure, HMOs inherently aim to reduce moral hazard by incentivizing health care providers to manage the allocation of healthcare services efficiently. It's a delicate balance intended to discourage unnecessary tests and procedures while simultaneously ensuring that no necessary care is withheld which might lead to worse health outcomes and higher costs down the line.
This system combats potential issues such as adverse selection, which occurs when there is asymmetry in information between the insurance company and insurance buyers, potentially leading to imbalances in the insurance pool. As healthcare evolves, many doctors are compensated through a mixed system incorporating elements of managed care and fee-for-service, aiming to strike a balance between controlling costs and providing quality care.