Risk Dis-Aggregation and Nursing Management: Risk Theory and the Management of Insurance Risk Assumption across Healthcare Systems

2.50
Hdl Handle:
http://hdl.handle.net/10755/147867
Type:
Presentation
Title:
Risk Dis-Aggregation and Nursing Management: Risk Theory and the Management of Insurance Risk Assumption across Healthcare Systems
Abstract:
Risk Dis-Aggregation and Nursing Management: Risk Theory and the Management of Insurance Risk Assumption across Healthcare Systems
Conference Sponsor:Sigma Theta Tau International
Conference Year:2007
Author:Cox, Thomas, PhD, RN, MS, MSW, MS, BA, BSN, RN
P.I. Institution Name:Green Trees Consulting
Title:Consultant
[Leadership session research presentation] Purpose: Describe risk theoretic mathematical tools and insights needed to manage the insurance risk assumptions by health care providers in insurance risk dis-aggregation instruments such as capitation and prospective payment systems across seemingly disparate health care systems. Background: Risk dis-aggregating and transferring health care finance mechanisms are ubiquitous. Some believe they encourage efficiency, facilitate local consumer and provider control, and improve service quantity/quality. However, proper analysis reveals that smaller patient cohorts increase the likelihood that reimbursement rates will prove actuarially unsound, requiring providers to reduce service quantity and/or quality. Actuarially unsound risk transfers limit services despite the best efforts of executives and bedside nurses. Approach: More functional economic, insurance, mathematical, and actuarial tools that can be used by nurses to manage institutional insurance risk assumption are reviewed and applied to different clinical settings and different health care systems. Major Points & Rationale: Nurses mediate institutional insurance risk assumption from bedside to trans-national health care systems. Insurance risk dis-aggregation affects free market, socialized, and blended health care systems. Whenever health care providers accept insurance risk transfers they must reduce service capacity. Using risk theoretic principles and tools, managers and executives will better assess and manage resources and optimize these reduced service levels. Early and accurate recognition of inadequate reimbursements and higher than feasible service demand characteristics is critical to successful nursing. Nurses using risk theory and statistical sampling theory will improve decision making, contracting and budgeting activities, and human and material resource management. Conclusions: Nurse managers and executives must accurately analyze the financial, staffing, equipment, and supply implications of institutional insurance risk assumption. Nurses who perform such analyses and understand the true impact of insurance risk assumption will create more efficient, effective, and stable nursing environments, while improving their human and material resource management.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleRisk Dis-Aggregation and Nursing Management: Risk Theory and the Management of Insurance Risk Assumption across Healthcare Systemsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/147867-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Risk Dis-Aggregation and Nursing Management: Risk Theory and the Management of Insurance Risk Assumption across Healthcare Systems</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Cox, Thomas, PhD, RN, MS, MSW, MS, BA, BSN, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Green Trees Consulting</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Consultant</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">tc_spirit@yahoo.com</td></tr><tr><td colspan="2" class="item-abstract">[Leadership session research presentation] Purpose: Describe risk theoretic mathematical tools and insights needed to manage the insurance risk assumptions by health care providers in insurance risk dis-aggregation instruments such as capitation and prospective payment systems across seemingly disparate health care systems. Background: Risk dis-aggregating and transferring health care finance mechanisms are ubiquitous. Some believe they encourage efficiency, facilitate local consumer and provider control, and improve service quantity/quality. However, proper analysis reveals that smaller patient cohorts increase the likelihood that reimbursement rates will prove actuarially unsound, requiring providers to reduce service quantity and/or quality. Actuarially unsound risk transfers limit services despite the best efforts of executives and bedside nurses. Approach: More functional economic, insurance, mathematical, and actuarial tools that can be used by nurses to manage institutional insurance risk assumption are reviewed and applied to different clinical settings and different health care systems. Major Points &amp; Rationale: Nurses mediate institutional insurance risk assumption from bedside to trans-national health care systems. Insurance risk dis-aggregation affects free market, socialized, and blended health care systems. Whenever health care providers accept insurance risk transfers they must reduce service capacity. Using risk theoretic principles and tools, managers and executives will better assess and manage resources and optimize these reduced service levels. Early and accurate recognition of inadequate reimbursements and higher than feasible service demand characteristics is critical to successful nursing. Nurses using risk theory and statistical sampling theory will improve decision making, contracting and budgeting activities, and human and material resource management. Conclusions: Nurse managers and executives must accurately analyze the financial, staffing, equipment, and supply implications of institutional insurance risk assumption. Nurses who perform such analyses and understand the true impact of insurance risk assumption will create more efficient, effective, and stable nursing environments, while improving their human and material resource management.</td></tr></table>en_GB
dc.date.available2011-10-26T09:37:24Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T09:37:24Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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