Risk Management Flashcards
The insurance perspective are 2 types of risk. What are they
- Speculative
- Pure
What is specultive risk?
Involves a chance to gain or benefit or a chance to lose
* not insurable
What is pure risk?
Risk where there is only the opportunity of sustaining a loss with no oppotunity for fain
* Accidental, unanticipated, unavoidable
Insurance can be used to manage exposure to risk
What is the purpose of developing a risk management strategy?
Protect the vital assets of a pharmacy, analyze and identify strategies to manage risk threats
What are the steps of a risk management process?
- Establish context: goals and vulnerability
- Identify and analyze risk: all aspects of pharmacy and potential risks
- Evaluate and prioritize risks: which has greater potential for loss
- Select an approriate risk management strategy and implement the technie: develop policy, insurance, riders, what risks can be avoided
- Monitor decision and update risk management program
What are riders?
Supplemental policies that provide coverge not covered in an original policy
What are the techniques used to manage risks?
- Risk avoidance
- Risk prevention/modification
- Risk absorptin/retention
- RIsk sharing/transfer
What is risk avoidance?
Impractical in community pharamcies, because can’t avoid dispensing med do to risk of med error
What is risk prevention/modification?
Reduces the chances of a risk occuring
What is risk absorption/retention?
Retaining or absorbing a certain degree of risk
What is risk sharing/transfer?
Aother party is involved
Ex: insurance company negotiate an agreement with the provider
Scope (extent) of protection provided under an insurance contract
Coverage
Provision that requires the insured part to share (absorb) some costs of covered services or losses on a fixed percentage basis
Co-insurance
Fixed $ amount of an insured loss to be paid (or absorbed) by the policyholder
Decuctible
Type of health insurance that provides monthly income to the policyholder if he or she becomes unable to work because of an illness or accident
Disbility insurance
Party covered by the insurance contract or persons entitled to benefits under the terms of the policy (i.e., family members)
Insured
Individual responsibility for causing injury to another person or damage to another person’s property through negligence
Liability
Failure to use reasonable care (i.e., failure to do something a reasonably prudent person would do in similar circumstances)
Negligence
Insurance term for risk, possible cause of injury, or event causing damage or loss
Peril
Written contract for insurance between an insurance company & insured party
Policy
Term used to describe a document that amends or changes the original policy
Rider
Form of insurance protection in excess of the amount covered by other liability insurance policies, which also protects the insured in situations not covered by usual liability policies
Umbrella liability
Policy that pays benefits to an employee (or family) for job-related injury or death
Worker’s compensation
What is property insurance?
Provides protection for the property and physical assets of a business (building, equipment, supplies, money, accounts, records)
What is liability insurance?
Protects a business against clainswhen its being sued for damages/injuries caused by neglegience
What is business owner’s policy?
COmbines property and liability coverage in the same policy for small business owners
* Broader coverag with less expensive premiums
* <100 employes
* DOesn’t include professional liability coverage, worers compensation, employee health insurance
What is individual professional liability insurance?
Protects an individual against claims resulting from actual or alleged errors, omissions, or negligence
* Organization’s policy are designed to protect the org not the individuals
What is ker person insurance?
Protect a business from loss if key individual (partner, owner) were to die or experience a disability
What is umbrella/excess liability?
Possibility for a lawsuit to exceed the limits of a primary liability protection policy
THis covers the difference between the base liability limits and the judgement amount
What is worker’s comp?
Covers med expenses to employees who have a job-related accident
Wha is diability insurance?
Provides income for an employee and family if an event prevents the employee from working
What is short term disability insurance?
<6 months, provides replacement for employee who are temporarily out of work
What is long term diability insurance?
Replaces employees salary if employee is unable to work >6 months, or premenantly diabled
Insurance coverage that is specialized to pharmacies, individualized to their specific needs?
Independent pharmacy insurance
What are the components of OBRA 90?
Required pharmacist providng medications to state Medicaid recipients to:
* Conduct DUR
* Provide patient counseling
* Maintain proper patient records
What is the purpose for HIPPA?
Health info proatbility and accountability act: created privacy standards for patients and health info
* Protects all “individually identifiable health information” held or transmitted by a covered entity
What type of info is protected by HIPAA?
- Demographic
- Health care provided
- Payment
How do you manage HIPAA in pharmacies?
- COnducting risk assessment
- Appointing securit and privacy officers to ensure compliance
