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Legal and Ethical Implications of Health Care Provider Insurance Risk Assumption

Cox, Thomas PhD, RN

JONA's Healthcare Law, Ethics, and Regulation: October-December 2010 - Volume 12 - Issue 4 - p 106-116
doi: 10.1097/NHL.0b013e3181ff0fa0

ABSTRACT From bedside to boardroom, nurses deal with the consequences of health care provider insurance risk assumption. Professional caregiver insurance risk refers to insurance risks assumed through contracts with third parties, federal and state Medicare and Medicaid program mandates, and the diagnosis-related groups and Prospective Payment Systems. This article analyzes the financial, legal, and ethical implications of provider insurance risk assumption by focusing on the degree to which patient benefits are reduced.

Correspondence: Thomas Cox, PhD, RN, 1711 NW 55 Terrace, Gainesville, FL 32605 (

Dr Cox is a consultant, in private practice, in Gainesville, Florida.

© 2010 Lippincott Williams & Wilkins, Inc.