Professional Caregiver Insurance Risk Resource Page

Thomas Cox PhD, RN
Mathematician
Statistician
Social Worker
Nurse
Researcher
Author
Psychotherapist
Chartered Property Casualty Underwriter
SMQT Health Facility Surveyor

Critical Issues

Insurers handle insurance risks more efficiently than individuals.

Large insurers handle insurance risks better than small insurers.

Managed care operations use capitation contracts, utilization review, and other tricks of the trade to handle insurance risks by transferring them to smaller organizations and employed health care providers.

Clients/Patients of managed care and integrated health care delivery systems are relying on their health care providers to correctly diagnose and treat them at the same time that these providers are acting as these patients health insurance companies - not a good idea at all.

Health Care Providers should not be acting as health insurers.

Health Care Providers are very inefficient insurers.

Managed Care Organizations do not provide better or more efficient care - they provide less care and less efficient care than care financed by indemnity insurance products.

Tax deductions of $5,000 for purchasing individual health insurance are wasteful, inefficient, and a regressive tax. Most families cannot afford the price of individual health insurance and most insurers do not want to waste time and money writing individual policies.

Individual health account tax benefits are useful for people earning more than $250,000/year. I don't know many people making less than that who expect to benefit from these high income tax breaks.

Health Care Intermediaries - the companies that unnecessarily stand between health care providers and health care payors are a lot like ENRON - they provide no intrinsically valuable products or services, divert funds away from health care providers and consumers, and reduce the availability of health care services - Billions of dollars wasted each and every year with no benefit to anyone but these companies while health care costs more and people receive fewer services.

Under construction!

This page contains links to some of my professional publications related to Professional Caregiver Insurance Risk.

Please note that all the materials on this and other pages on this website, whether specifically stated or not, are copyright 2008 by Thomas Cox PhD, RN. Materials whose copyright holder are different will be very obvious.

In doubt? Assume the copyright is mine.

I encourage the use of these materials with appropriate citation and credit for my intellectual work products, in order to further the recognition of the failure of managed care and insurance risk transfers.

DISSERTATION

Cox, T. (2004). Risk induced professional caregiver despair: A unitary appreciative inquiry. This is an extract of what I consider to be the best parts of my dissertation. pdf

PCIR RELATED PUBLICATIONS

Cox, T. (2007). Why capitation? eLetter response to Hoangmai H. Pham and Paul B. Ginsburg
Unhealthy Trends: The Future Of Physician Services, Health Affairs, November/December 2007; 26(6): 1586-1598. Available at http://content.healthaffairs.org/cgi/eletters/26/6/1586

Cox, T. (2007). Nursing Research in 2050. Nursing Science Quarterly. 20(3), 206-208. pdf

Cox, T. (2007). Book Review: Betraying the NHS: Health Abandoned by Michael Mandelstam. Journal of Psychiatric Mental Health Nursing, 14(7): 715-716. pdf

Cox, T. (2007). Pondering The Future of Humanity: Reflections On John Glad's Future Human Evolution: Eugenics in the Twenty-First Century. Journal of Psychiatric Mental Health Nursing. 14, 325-329 pdf

Cox, T. (2006). Acausality: What it is and what it is not and why I am not an anti-causalist - with deep felt apologies to Florence Nightingale and Bertrand Russell. Visions: The Journal of Rogerian Nursing Science, 14(1): 58-64. pdf

Cox, T. (2006). Professional caregiver insurance risk: A brief primer for nurse executives and decision-makers. Nurse Leader, 4(2): 48-51. pdf

Cox, T. (2006). Review of Hinderer, D.E. & Hinderer, S.R. (2001). A multidisciplinary approach to health care ethics. California: Mayfield Publishing Company. Nursing Philosophy, 7:183-184. pdf

Cox, T. (2006). Letter to the editor in response to: Physician, Anonymous. (January 6, 1997). Clueless in the land of managed care. Online Journal of Issues in Nursing, 2(2). Available at http://www.nursingworld.org/ojin/tpc2/tpc2_2.htm. Online Journal of Issues in Nursing. Available at http://www.nursingworld.org/ojin/letters/t2e7.htm Published online: March 27, 2006.

Cox, T. (2005). Professional Caregiver Insurance Risk, Medical Outliers, and the Duty to Treat Comment on The obligation of physicians to medical outliers: a Kantian and Hegelian synthesis by Thomas J Papadimos and Alan P Marco. BMC Medical Ethics 2004, 5:3. Article available at: http://www.biomedcentral.com/content/pdf/1472-6939-5-3.pdf Comment available at : http://www.biomedcentral.com/1472-6939/5/3/comments Published online: June 10, 2005.

Cox, T. (2005). Professional caregiver insurance risk and the rising costs of health care Rapid response to High and rising health care costs. Part 1: Seeking an explanation by Thomas Bodenheimer, MD. Annals of Internal Medicine, 142: 847-854. Available at http://www.annals.org/cgi/eletters/142/10/847#1739 Published online: June 13, 2005.

Cox, T. (2005). Patient Safety and Nursing Education.[Letter to the editor]. Journal of Nursing Scholarship, 37(2):97. pdf

Cox, T. (2004). Risk induced professional caregiver despair: A unitary appreciative inquiry. Visions: The Journal of Rogerian Nursing Science, 12(1): 64-64. pdf

Cox, T. 2004). Transgressing the boundaries of science: Glazer, scepticism, and Emily's experiment Nursing Philosophy, 5: 75-78. pdf

Cox, T. (2003). A nurse-statistician reanalyzes data from the Rosa therapeutic touch study, Journal of Alternative Therapies in Health and Medicine, 9(1): 58-64. pdf

Cox, T. (2003). Risk and nursing: Financial implications of prospective funding. The International Nurse, 16(2); 5. pdf

Cox, T. (2001). Risk theory, reinsurance, and capitation. Issues in Interdisciplinary Care, 3(3): 213-218. pdf

Cox, T.: (1990). Comment on Regression estimates in federal welfare quality control programs by M. H. Hansen and B. J. Tepping, Journal of the American Statistical Association, 85. (No copy yet). This comment addressed the flawed Reagan era program that concentrated on rooting out fraud in the Food Stamp program. At the same time the Federal and State governments were spending hundreds of millions of dollars on auditing the accounts of individual food stamp recipients, the Savings and Loan crisis was being ignored. So, net result, savings as a result of improved quality control in food stamps dwarfed by the costs of the quality control program which was, in turn, dwarfed by the losses in the Savings & Loan industry.

Special

These papers are particularly significant in terms of the groundwork for my explorations of Professional Caregiver Insurance Risk. The first paper below was the result of a 1974 health care planning study for the town of Shelter Island, NYconducted by me under the auspices of the State University of New York at Stony Brook.

Jonas, S., Cox, T. and Lamont, C.T. (1977). Family medicine residency program in a Semirural setting? Development of a plan. New York State Journal of Medicine. (No copy yet).

Cox T. (2001). "The relationship between providers and consumers of mental health services: Vulnerabilities and Rights of the Marginalized: Autoethnographic Reflections, Theoretical Constructs and Implications for Advanced Practice Nursing". This paper was my Psychiatric Mental Health Nursing Master's degree Final Synthesis Project. I incorporated material from a section of my Master's thesis in social work (1975), specifically the section on "The Social Reality of Mental Illness". The second piece was a paper I originally wrote during my social work studies in 1974-5 which led to a more complete paper called "Denial of Services in Public Agencies: A White Collar Crime" derivatives of which were presented at conferences in the late 1970s. pdf

Why you might want to check this site out more thoroughly

Are you trying to understand why your 'health insurer' is denying your benefits?

Are you trying to understand why your health provider seems more interested in delaying your care than providing it?

Are you running out of time or money but you are still sick?

Do you wonder whether Managed Care or Capitation contracts are compromising your care?

Are you an attorney wondering how to best represent clients denied health care access, benefits, timely diagnosis and treatment?

Are you a health care educator or researcher trying to understand the impact of health care finance issues on access to health care?

Are you on Medicare or Medicaid and cannot find a physician in your local community at a fee you can afford?

Are you a community/health care advocate who is trying to understand why health care services are collapsing in your area?

Are you a doctor, advanced practice, registered or practice nurse

This is where you need to be!

Click on the Quick links menu for answers to all your questions.