title: Must a risk-assuming healthcare provider have an insurance license?
abstract: With the growth of managed care has come the question of whether a risk-assuming provider organization must be licensed to sell insurance. The debate centers on whether capitation arrangements represent an insurance risk or a business risk and whether states have the right to regulate agreements between providers and self-insured employers. A flexible, reasonable approach will be needed if legislators decide to regulate providers that assume varying degrees of risk.
authors.affiliation: American Medical Association, Chicago, IL, USA.
authors.forename: E B
authors.initials: EB
authors.lastname: Hirshfeld
mesh_terms: D019461:Employee Retirement Income Security Act; D006264:Health Benefit Plans, Employee; D007348:Insurance, Health; D008004:Licensure; D008329:Managed Care Programs; D014481:United States