HMOs: Origins and Development

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Abstract
Health maintenance organizations (HMOs)1 2 3 4 5 6 7 were first developed on a large scale around the turn of the 19th century, but were not then known as HMOs. These earliest forms were called prepaid group practices, and most of them originated in the American Northwest. They came about largely as a result of the opening up of the West by the railroads and were a part of the industrial development that followed.Probably the first example of such a prepaid group practice was the Western Clinic in Tacoma, Washington. Turn-of-the-century Tacoma was the lumber capital of the world, and mill owners and their . . .

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