Thomas Cox PhD, RN
I am a mathematician, statistician, social worker, and registered nurse. My area of acute interest is risk transferring health care finance mechanisms.
In essence, a critique of managed care and capitation funded health care.
Managed care and its primary cost control mechanism, Capitation, put health care providers in the insurance business. Health care providers are very inefficient insurers and the consequence of this approach is that the quality and quantity of services available are far below the levels available in tradtional insurance mechanisms.
People who think capitation and health provider insurance risk assumption will create a more efficient health care system are either incredibly misguided or intentionally misleading an unwary public.
The most efficient health care finance system would be a single, not-for-profit, national health insurer. Any insurer smaller than this is less efficient. Any profit making insurer pulls resources away from service provision.
This is not a political position – it is an actuarial fact. You can advocate smaller insurers and profit making insurers but you ought to acknowledge that your intent is not to create an efficient health care finance system but to create an inefficient health care finance mechanism.