Just had my latest paper published in the Journal of Healthcare Risk Management:
Cox, T. (2011), Exposing the true risks of capitation financed healthcare. Journal of Healthcare Risk Management, 30: 34–41. doi: 10.1002/jhrm.20066
The key points:
Small insurers are inefficient insurers: They have lower probabilities of achieving modest profit goals, higher probabilities of incurring operating losses, and higher probabilities of insolvency than larger insurers when both randomly select policyholders from the same populations.
Small insurers also have to cut benefits to match larger insurer’s probabilities of achieving modest profit goals, avoiding operating losses, and avoiding insolvency.
Despite this, and the obvious impact it has on service quality and quantity, almost every proposal for trimming health care costs assumes Read more
I was just thinking about a new paper in the American Journal of Managed Care:
Regulating the Medical Loss Ratio: Implications for the Individual Market
Jean M. Abraham, PhD; and Pinar Karaca-Mandic, PhD
(Am J Manag Care. 2011;17(3):211-218)
In 2009, using a PPACA-adjusted MLR definition, we estimated that 29% of insurer-state observations in the individual market would have MLRs below the 80% minimum, corresponding to 32% of total enrollment. Nine states would have at least one-half of their health insurers below the threshold. If insurers below the MLR threshold exit the market, major coverage disruption could occur for those in poor health; we estimated the range to be between 104,624 and 158,736 member-years.”Conclusion: The introduction of MLR regulation as part of the PPACA has the potential to significantly affect the functioning of the individual market for health insurance.”————————————————————————————————————————
The Robert Wood Johnson Foundation thought enough of it to post it on their website and I did a post over there
but sometimes they don’t like them, so I’ll edit it and redo it here because I think Read more
Was just reading: “Bringing Values Back Into Evidence-Based Nursing: The Role of Patients in Resisting Empiricism” by Porter, O’Halloran, and Morrow.
What a great article. Nails a number of things that I have been tangentially interested in. Without in any way suggesting a deficit it was interesting to me that little attention seemed to be given to “how” and “why” we got here: How and why we have slipped up and where we must go to get out of the hole so many of us feel we are in.
So here are some additional thoughts on their article. Read more