Health Care Risk Management: Organization and Claims Administration

More than ever before, health care facilities and professionals need to guard against unexpected financial losses from casualty, worker's compensation, and professional liability. Risk management is that complex set of tasks, functions, and decisions carried out with the objective of reducing such losses. The field of risk management in the health-care industry developed out of the deluge of malpractice cases which stunned the medical community in the late 1960s and led to soaring insurance claims and premiums.

This book treats all the broad and divergent elements of health care risk management, and is aimed at students, instructors, management, and health professionals alike. Risk management is divided into three processes: exposure of risk identification; risk measurement or evaluation; and risk handling or treatment. Managers first analyze exposure areas of an organization so that risks contained within it can be identified. Next they evaluate the risk by applying analytical skills and decision-making techniques to the risk areas to determine their potential for occurrence and the inherent financial impact. Finally, managers decide how the risks that have been identified and measured are to be handled by the organization. Risk handling includes risk financing, which may include retention, transfer, and self-financing of risks and exposure areas; and risk control, which includes avoidance, shifting, and prevention of risks.

The text provides meaningful exercises, extensive references, and a comprehensive glossary of terms. It is well balanced, thorough, and provides an excellent overview of its subject.