Latest paper

My latest published paper on PCIR came out about a week ago.

Cox, T. (2010). Legal and Ethical Implications of Health Care Provider Insurance Risk Assumption. JONA's Healthcare Law, Ethics, & Regulation: 12(4); 106-116.


http://journals.lww.com/jonalaw/Abstract/2010/10000/Legal_and_Ethical_Implications_of_Health_Care.5.aspx

Highlights:

Assuming the risk assuming providers are smaller than the risk transferring MCOs, Insurers, and Medicare/Medicaid programs:

1. Risk assuming health care provider's probabilities of modest, sustainable profits are lower than the probabilities of modest, sustainable profits for entities transferring risks, when they retain their insurance risks.

2. Risk assuming health care provider's probabilities of operating losses are higher than the probabilities of operating losses for entities transferring risks, when they retain their insurance risks.

3. Risk assuming health care provider's probabilities of severe, solvency threatening operating losses are far higher than the probabilities of severe, solvency threatening operating losses for entities transferring risks, when they retain their insurance risks.

4. Risk assuming health care provider's abilities to provide services at, or above, the level assumed in the risk transferring entities’ premiums are significantly lower than entities transferring risks, when they retain their insurance risks. Efficient providers ‘must’ reduce services to patients solely because they accept insurance risks.

5. Risk assuming health care provider's aggregate surplus requirements, assuming modest protection from their exposure to solvency threatening losses, are far higher than the aggregate surplus requirements for larger, risk retaining entities managing the same patient portfolios. Trillions of dollars compared to millions (or less) for large, risk retaining insurers.