Professional Caregiver Insurance Risk: Actuarial and Decision Making Tools for Nurse Managers and Executives

2.50
Hdl Handle:
http://hdl.handle.net/10755/163400
Category:
Abstract
Type:
Presentation
Title:
Professional Caregiver Insurance Risk: Actuarial and Decision Making Tools for Nurse Managers and Executives
Author(s):
Cox, Thomas
Author Details:
Thomas Cox, Associate Professor, Seton Hall University Department of Supportive Sciences and Health Systems, Gainesville, Florida, USA, email: coxthomb@shu.edu
Abstract:
Purpose: This paper defines and provides mathematical tools to more effectively manage professional caregiver insurance risk, the assumption of insurance risk by health care providers occurring in capitation agreements, prospective payment plans, managed care, and budgeted nursing environments. Actuarially unsound reimbursement practices may adversely affect providers and constrain services available to consumers if not properly addressed by nursing executives and managers. Background: Risk or profit sharing health care finance mechanisms, such as: managed care, prospective payment systems, and capitation agreements may appear benign: encouraging efficiency and minimally impacting service quantity or quality. However, provider focused, actuarial analysis of these mechanisms shows that when insurers transfer insurance risks associated with small numbers of patients to providers, portfolio size differentials often result in actuarially unsound reimbursement rates. Approach: Basic economics, insurance, mathematical, and actuarial tools insurers use to manage risk were reviewed and applied to nursing service management imperatives. Using these principles and tools, nursing managers and executives may improve institutional risk management and service quality. Major Points & Rationale: Nursing executives and managers play critical roles in mediating the impact of institutional risk assumption on bedside care. Effective risk management will enhance the ability of nursing managers and bedside caregivers to respond to highly variable demands for nursing resources and services. Nurse managers and executives using tools derived from actuarial risk theory, statistical sampling theory, and game theory to analyze past and future costs will improve their financial decision making, contracting outcomes, intra-organizational resource management, and will improve their evaluations of the performance of executives, managers, and individual caregivers. Conclusions: Nurse managers and executives who recognize and appropriately analyze the financial, staffing, equipment, and supply needs attendant to insurance risk assumption, will create more efficient and effective nursing environments, promote greater stability in operating characteristics, and better match available resources and highly variable service demands.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2006
Conference Name:
18th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
Cherry Hill, New Jersey
Description:
�New Momentum for Nursing Research: Multidisciplinary Alliances�, held on April 20th -22nd at the Hilton in Cherry Hill, New Jersey
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleProfessional Caregiver Insurance Risk: Actuarial and Decision Making Tools for Nurse Managers and Executivesen_GB
dc.contributor.authorCox, Thomasen_US
dc.author.detailsThomas Cox, Associate Professor, Seton Hall University Department of Supportive Sciences and Health Systems, Gainesville, Florida, USA, email: coxthomb@shu.eduen_US
dc.identifier.urihttp://hdl.handle.net/10755/163400-
dc.description.abstractPurpose: This paper defines and provides mathematical tools to more effectively manage professional caregiver insurance risk, the assumption of insurance risk by health care providers occurring in capitation agreements, prospective payment plans, managed care, and budgeted nursing environments. Actuarially unsound reimbursement practices may adversely affect providers and constrain services available to consumers if not properly addressed by nursing executives and managers. Background: Risk or profit sharing health care finance mechanisms, such as: managed care, prospective payment systems, and capitation agreements may appear benign: encouraging efficiency and minimally impacting service quantity or quality. However, provider focused, actuarial analysis of these mechanisms shows that when insurers transfer insurance risks associated with small numbers of patients to providers, portfolio size differentials often result in actuarially unsound reimbursement rates. Approach: Basic economics, insurance, mathematical, and actuarial tools insurers use to manage risk were reviewed and applied to nursing service management imperatives. Using these principles and tools, nursing managers and executives may improve institutional risk management and service quality. Major Points & Rationale: Nursing executives and managers play critical roles in mediating the impact of institutional risk assumption on bedside care. Effective risk management will enhance the ability of nursing managers and bedside caregivers to respond to highly variable demands for nursing resources and services. Nurse managers and executives using tools derived from actuarial risk theory, statistical sampling theory, and game theory to analyze past and future costs will improve their financial decision making, contracting outcomes, intra-organizational resource management, and will improve their evaluations of the performance of executives, managers, and individual caregivers. Conclusions: Nurse managers and executives who recognize and appropriately analyze the financial, staffing, equipment, and supply needs attendant to insurance risk assumption, will create more efficient and effective nursing environments, promote greater stability in operating characteristics, and better match available resources and highly variable service demands.en_GB
dc.date.available2011-10-27T11:06:54Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:06:54Z-
dc.conference.date2006en_US
dc.conference.name18th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationCherry Hill, New Jerseyen_US
dc.description�New Momentum for Nursing Research: Multidisciplinary Alliances�, held on April 20th -22nd at the Hilton in Cherry Hill, New Jerseyen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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