The model for managed care known as the health maintenance organization was developed by Dr. Ellwood, who died on Monday. There was a man who was 95 years old.
Barbara Ellwood said his death was due to organ failure.
The father of the H.M.O. was Dr. Ellwood, who devoted himself to national health reform in the late 1960s, and many others made important contributions to the concept.
In 1970 Dr. Ellwood came up with the term H.M.O., a partnership in which doctors are paid for the number of patients they see, not for each service given, and whose members are guaranteed access to network doctors and
Dr. Ellwood's idea was for large nonprofits to compete for patients by providing the best care at the lowest price and that would contain costs by keeping patients healthy to begin with.
The elements of a system based on market forces have been around for a long time.
His plan got a fateful hearing in a chance meeting on an airplane with a Nixon administration official, and after extensive consultations with the White House, it became a cornerstone of national policy, with the aim of giving consumers a wider choice of health plans.
The Health Maintenance Organization Act was enacted in 1973. Employers with 25 or more workers were required to give H.M.O. options with their health insurance plans. Millions of Americans signed up after a slow start because of the cost containment features in the law.
There are more than 70 million people in the United States who are Enrolled in H.M.O.s. H.M.O.s are among the least expensive providers of medical care in a nation where medical expenditures are 18 percent of the Gross Domestic Product.
H.M.O.s offer high-quality services while cutting unnecessary treatments and hospitalizations. Critics have argued for a long time that pre-paid plans are not good for your health. Studies show that elderly and poor patients fare worse in H.M.O.s, and some patients complain that the rules unfairly limit their choice of doctors.
After federal and state policy changes encouraged the growth of for-profit H.M.O.s., Dr. Ellwood was concerned about the effects of cost controls on quality of care. As H.M.O.s grew and became profitable, he voiced his disappointment with the way his original ideas had worked out.
He told The New York Times in 1996 that only a small part of his dream for the American health care system has been realized. There's a lot of unfinished business.
One of the two children of Paul and Mary Ellwood was born in San Francisco. He was raised in Oakland where his mother was a nurse and his father was a family doctor.
After graduating from Oakland High School, Paul joined the Navy and served in the Philippines during World War II. He earned a bachelor's degree in 1949 and a medical degree in1953 at the university.
After completing his internship at the University of Minnesota, he was posted to the Sister Kenny Institute in Minneapolis, where he was in charge of a Polio Clinic. He went on to become a professor at the university. The American Rehabilitation Foundation became a rehabilitation hospital after the development of thepolio vaccine.
Dr. Ellwood found children crying on his rounds. He realized that the kids didn't need to be in the hospital. Insurance companies wouldn't pay for care if the children were hospitalized, that's why they were there. He thought there was something crazy about the incentives.
He realized that doctors made more money if they performed more services, that most doctors and hospitals benefited from the illness of patients, not their health, and that they were organized to react to illness, not prevent it.
While still working for the American Rehabilitation Foundation, Dr. Ellwood formed a health policy research group called Interstudy, which explored ways to apply business management techniques to improve health care. One of the nation's largest health companies was formed after it set up an H.M.O.
A group of doctors, economists, academics and policymakers met at Dr. Ellwood's home periodically for decades to discuss new health care strategies after he gave up his medical career.
Bill Clinton used the group's most notable report when he pledged to reform the health care system. After Mr. Clinton was elected, Dr. Ellwood and others came up with a plan for health reform.
It would have made it possible for businesses and individuals to purchase insurance from partnerships of doctors, hospitals and insurers competing for the business. The plan was shepherded by Hillary Clinton and it failed in 1994.
The president of the Jackson Hole Group retired in 2002. He and his first wife had three children. They divorced in 1990 after Elizabeth Ann's death. He wed Barbara Winch in 2000. Dr. Ellwood is survived by his family.
He advocated for a national database to show how the treatment of patients works out. He argued that health care providers and policymakers had no way of knowing if care was being compromised to cut costs or if reforms were needed.
In a 2010 interview with Dr. Anthony R. Kovner, Dr. Ellwood worried that theAffordable Care Act included some of the "fatal weaknesses" of H.M.O.s.
The Federal Reserve is a good example of a national health institution.
He wants a similar thing in health care. We need to create an agency to collect health outcomes data, isolated from the rest of the government and the rest of the health system, and use its findings to determine what it is that's worth spending public or private money on for health care.
Maia Coleman reported.
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