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.

Over the years I have discussed Professional Caregiver Insurance Risk with people in many different fields. The boon and bane of Professional Caregiver Insurance Risk is that it is so fundamental a concept that it applies in every area of modern life. The same fundamentals of Professional Caregiver Insurance Risk apply to health care, finance, facilities as diverse as assisted living facilities and university based health facilities. But these concepts also apply to sub-prime mortgages, stock markets, economics, logistics, operations research, dynamic programming, utility theory, planning, disaster preparedness, research, education, ethics, sociology, psychology, pharmacology, biostatistics, mathematics. In short the risk theoretic explanation of Professional Caregiver Insurance Risk applies to everything.

The advantage of this is that virtually regardless of the domain of expertise you come from, we could engage in productive partnerships to write papers, prepare presentations, develop educational materials, research grants, or simply dialogue about the impact of Professional Caregiver Insurance Risk on modern life.

The disadvantage of this is that the misunderstanding of these core principles is so deep and broad that the biggest problem people face in understanding Professional Caregiver Insurance Risk, is clearing the cobwebs of misunderstanding so that we can, as that little boy of fable could, understand that the "Emperor has no clothes".

If you think Professional Caregiver Insurance Risk applies to your work, I encourage you to contact me and work with me on joint publications and presentations.

If you are unsure as to whether you think Professional Caregiver Insurance Risk applies to your work, I encourage you to contact me and ask. I have yet to be stumped on connecting my work to the work of other researchers, teachers, and clinicians.

Cox, T. (2001) Rogers' Science of Unitary Human Beings Applied to Capitation Contracts. An old course paper. pdf

Cox, T. (Circa 2000) Collaborative Research Interests. This was a trajectory I developed back in 2000 I think. Interestingly enough, it does not contain any reference to "Professional Caregiver Insurance Risk". That is because I hadn't named this phenomena back then - I was still referring to it as "Average Cost-Based Reimbursement Plans" and wasn't even sure what role it would play in my future nursing career. It isn't current but it should give some ideas about the scope of my possible interests. pdf

Cox, T. (2005). This is a paper I wrote in a moment of whimsy - sort of an Ode to Florence Nightingale. It is better than I thought after 3 1/2 years of rest. I cleaned it up a bit but the table referred to will take a bit more time. Still, the Sigma Theta Tau poster from 2006 has a similar table and graph. 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.