Risk Management in Healthcare

Risk management in healthcare

HC 463

Third Party Reimbursement and Risk Management

30th September, 2011

Table of Contents

Introduction 3

Role of Risk Management Health Care Organizations 4

Risk Management in Healthcare Spectrum 5

Impact of Risk Management 7

Risk Management and the Government Regulatory Environment 8

Role of Interest Groups and Healthcare organizations 9

Strategies and Recommendations 10

Impact of Risk Management on Health Care Policy 11

Conclusion 12

References 13

Introduction

Risk management is defined as “the identification, analysis and evaluation of the risk and the selection of the most dangerous methods of treating it” (American Association of Healthcare Risk Management, 2009, p.11). It can also be defined as a “logical and systematic method of identifying, analyzing, treating and monitoring of the risks involved in healthcare” (Kavaler & Spiegel, 2003, p. 4).

Patient care has been considered a fundamental issue due to enhanced consumer education - people’s expectation of a healthy baby and the litigious nature of the modern society; all these factors have led to increased awareness of risk management by health care institutions. Risk management is about a probability that a particular risk might result in poor outcome and it seeks to minimize such probability. The dynamics of health care has prompted unprecedented changes in approaches to risk management to address the demands of the patients.

Because of health success, there has been an increase in the population of aging people; there is also increase in the population of people living with more than one chronic condition. This has led to new and long term demands for health care. It is estimated that chronic conditions will be the leading cause of deaths and disabilities if they are not prevented or managed well, consequently patients suffering from diabetes have higher health care costs, at least three times...