Professional Caregiver Insurance Risk: Impacts on Health Care Providers, Consumers, and Communities

2.50
Hdl Handle:
http://hdl.handle.net/10755/152385
Type:
Presentation
Title:
Professional Caregiver Insurance Risk: Impacts on Health Care Providers, Consumers, and Communities
Abstract:
Professional Caregiver Insurance Risk: Impacts on Health Care Providers, Consumers, and Communities
Conference Sponsor:Sigma Theta Tau International
Conference Year:2005
Author:Cox, Thomas, PhD, RN
P.I. Institution Name:Seton Hall University, College of Nursing
Title:Associate Professor
Co-Authors:Bonnie Sturm, EdD; Katherine M. Willock, PhD, APRN, BC; Patricia E. Kizilay, EdD, CS, ARNP-BC; Marion C. Lapchak, MSN, MBA, MS, RN
Objective: Define and describe Professional Caregiver Insurance Risk (PCIR), its impact on providers and consumers, particularly vulnerable populations. Design: Risk theoretic analysis of the impact of insurance risk transfers on health care providers and organizations (HCPs), explicating the impact of portfolio transfers from insurers, to HCPs, and describing how PCIR transfers limit resources for marginalized HCPs and consumers using individual presentations showing these impacts. Population, Sample, Setting, Years: Affected populations include HCPs and consumers in marginalized communities such as urban and exurban areas, vulnerable consumers, disease specific populations, and chronically ill clients. Concept or Variables Studied Together: PCIR is financial and insurance risk assumed by HCPs in capitation, DRG, HMO, and nursing operations. PCIR limits revenues and obligates HCPs to perform uncertain levels of service, constraining operations, and reducing services to compensate for necessary premium inadequacies. PCIR disadvantages consumers and HCPs by eliminating insurance benefits, destabilizing HCPs financially, moving insurance claims management to bedsides, and decreasing operational efficiencies. Methods: This symposium uses small sample theory to explicate the impact of PCIR transfers on HCPs, demonstrating higher relative risks of financial ruin in HCPs compared to financially stronger, insurers. Additional presenters apply PCIR insights to assess and reveal consequences of PCIR on HCPs and marginalized consumers. Findings, Conclusions and Implications: PCIR forces HCPs to manage insurance/financial risks. Insurance risk assumption creates ethical, legal, and financial conflicts incompatible with trusted caregiving, and compromising clients and HCPs. Healthcare financing mechanisms must insulate HCPs from insurance risk assumption, guarantee access to care, and insure the integrity of the insurance market by preventing inappropriate PCIR transfers. Nurses from bedside to advanced practice must understand PCIR transfers, recognizing that while providers profit, most must reduce service capacity and delivery, address needless ethical conflicts, non-existent in traditional insurance aggregation and risk retention.
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.titleProfessional Caregiver Insurance Risk: Impacts on Health Care Providers, Consumers, and Communitiesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/152385-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Professional Caregiver Insurance Risk: Impacts on Health Care Providers, Consumers, and Communities</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">2005</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Cox, Thomas, PhD, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Seton Hall University, College of Nursing</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Associate Professor</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">coxthomb@shu.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Bonnie Sturm, EdD; Katherine M. Willock, PhD, APRN, BC; Patricia E. Kizilay, EdD, CS, ARNP-BC; Marion C. Lapchak, MSN, MBA, MS, RN</td></tr><tr><td colspan="2" class="item-abstract">Objective: Define and describe Professional Caregiver Insurance Risk (PCIR), its impact on providers and consumers, particularly vulnerable populations. Design: Risk theoretic analysis of the impact of insurance risk transfers on health care providers and organizations (HCPs), explicating the impact of portfolio transfers from insurers, to HCPs, and describing how PCIR transfers limit resources for marginalized HCPs and consumers using individual presentations showing these impacts. Population, Sample, Setting, Years: Affected populations include HCPs and consumers in marginalized communities such as urban and exurban areas, vulnerable consumers, disease specific populations, and chronically ill clients. Concept or Variables Studied Together: PCIR is financial and insurance risk assumed by HCPs in capitation, DRG, HMO, and nursing operations. PCIR limits revenues and obligates HCPs to perform uncertain levels of service, constraining operations, and reducing services to compensate for necessary premium inadequacies. PCIR disadvantages consumers and HCPs by eliminating insurance benefits, destabilizing HCPs financially, moving insurance claims management to bedsides, and decreasing operational efficiencies. Methods: This symposium uses small sample theory to explicate the impact of PCIR transfers on HCPs, demonstrating higher relative risks of financial ruin in HCPs compared to financially stronger, insurers. Additional presenters apply PCIR insights to assess and reveal consequences of PCIR on HCPs and marginalized consumers. Findings, Conclusions and Implications: PCIR forces HCPs to manage insurance/financial risks. Insurance risk assumption creates ethical, legal, and financial conflicts incompatible with trusted caregiving, and compromising clients and HCPs. Healthcare financing mechanisms must insulate HCPs from insurance risk assumption, guarantee access to care, and insure the integrity of the insurance market by preventing inappropriate PCIR transfers. Nurses from bedside to advanced practice must understand PCIR transfers, recognizing that while providers profit, most must reduce service capacity and delivery, address needless ethical conflicts, non-existent in traditional insurance aggregation and risk retention.</td></tr></table>en_GB
dc.date.available2011-10-26T11:34:18Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T11:34:18Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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