Professional Caregiver Insurance Risk Resource Page

Thomas Cox PhD, RN
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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.

1. I don't see what the contracts my doctor engages in have anything to do with me - why should I care whether my doctor is taking risks?

The first and foremost reason to be concerned is that you do not know whether your doctor, hospital, or other health care provider is providing the services you really need. If you consider what has happened on Wall Street in September, 2008 was an unpredictable event, you probably will be surprised when you find out that you are not getting the same diagnostic and treatment opportunities that some of his/her patients are receiving. You may be getting an office examination while another patient is getting an MRI. In effect, if you do not understand the contracts your doctor is entering into you can't tell whether he/she is gambling with your health or taking a reasonable risk.

2. I am a doctor. I don't have any choice. I can work for an HMO or big medical practice, or I can leave medicine. Either way, I have to live with the cards I have been dealt, don't I?

You do, in an existential sense, have choices. Clearly, as a doctor you would sacrifice, as you already have, if you chose not to work within a system that is clearly unethical. But, there is no alternative that will resolve the problems we have other than ethical physicians and health care providers refusing to do something they should never have been encouraged to do in the first place. Health care providers cannot function as insurers and clinicians at the same time - the two roles are simply incompatible. If no physician was amenable to working in such practices the companies that have amassed great fortunes by limiting patients' rights and constraining doctors' clinical options would crumble and die. Sadly, a lot of people who invested in Managed Care companies and Integrated Health Care System stocks and bonds will lose a lot of money - but they never should have invested in these companies to begin with. What they did, was very similar to the people who invested in mortgage backed derivatives - investing in companies who produced far less value than they claimed.

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.