Description: Social determinants of health (SDoH) have been a topic of growing interest in recent years, yet consensus about what the phrase represents and how health-related social needs should be studied or addressed by employers, health plans, providers and other stakeholders in the business of health care have been lacking. For many, low-income populations come to mind when considering the topic, yet SDoH include a wide range of factors beyond income. Many types of data are available, yet each presents distinct challenges and opportunities for analysis. In this article, we describe some of the underlying context for considering SDoH, as well as some of the potential data sources to consult and challenges to grapple with on this important topic.

Description: Countries developing universal health care via an insurance vehicle face a variety of challenges. Deciding which benefits to include, where to proactively manage health, and how to reimburse network providers are just a sampling of the issues governments concurrently manage. Optimal choices are data-driven responses. For example, high rates of cervical cancer or increasing narcotics prescriptions are trends that can be managed through product changes, modified network payment structures, or even employer based outreach. This kind of information is typically gleaned from established health insurance claims data. However, in emerging health insurance markets, this level of granular claims data is largely missing. It is difficult to manage medical trend when the root causes are unclear. This article explores a pilot medical underwriting project in Jordan.

Description: The Canadian public health care delivery system continues to experience growing needs for increased funding. The total health care delivery system today costs Canadians $98 billion a year or about 9.7 percent of GDP. Of that total cost, 71 percent is paid by the government, which means the taxpayers. While that may pale in comparison to the costs in the U.S., it does make the Canadian system one of the five most expensive health care delivery systems in the world. While today’s cost pressures are of major concern, of even more concern are the costs being projected by many participants in the current health care debate for the period when the Baby Boom makes higher demands on the Canadian health care delivery system. Traditional projection methods, however, do not differentiate between the elderly who survive the year versus those who die as to their use of health care systems. This paper first looks at the impact that this differentiation could have on projected costs. Second, the paper looks at the impact that the wide use of Advance Directives [also called Living Wills] might have on future health care costs and some of the issues surrounding their use. From Actuarial Research Clearing House 2004, Vol. 1.

Description: The last three decades have witnessed an important rise in number of people with diabetes in Asia, especially Type 2 Diabetes. Like no other common condition, numerous innovations are currently entering the healthcare system that will soon have a significant impact on management of the condition. This presentation explores the role played by sensors/wearables, artificial intelligence, new drugs and diabetes apps. We assess the realistic potential of such advancements and give an outlook on medium-term pricing and product development.

Description: The objective of this project is to summarize the existing literature on end of life issues of interest to actuaries, and to document a broad list of such articles. The end of life issues explored are multi-dimensional and from multiple perspectives. When considering cost implications of end of life care, it is necessary to consider cost in a broad context as it is a measure that cannot solely be defined by dollars. Other dimensions of cost, such as quality of care, family care giving, communication, patient preferences and access to care, should also be explored.

Description: This article examines the costs of mental health parity, presents the primary drivers of cost increases from legislation and shows evidence the initial cost projections were too high. From Health Section News, March 2005, Issue No. 49.

Description: A panel of experts discusses the effect of malpractice costs on health care delivery and health insurance, and potential solutions to reducing the costs of malpractice, including research on limiting human error and possible litigation reforms. From the Record of the Society of Actuaries, Volume 29, No. 3, Session 118

Description: Discussion and Opinion on how randomness affects measurement of provider contracting risk-sharing agreements

Description: A call for essays issued by the SOA Health and Long Term Care Sections on the visions for the future of the U.S. health care system.

Description: There have been a variety of proposals related to expanding eligibility for Medicare, ranging from a publicly funded program to a full buy-in option. This session will explore the actuarial implications of various buy-in proposals and the potential impact that such policy changes could have on the health care market landscape. In particular, we will discuss the ways in which program eligibility requirements, plan designs, provider reimbursement arrangements, network design, rating rules, and subsidies could affect premium levels and membership volume in a Medicare buy-in market, as well as the potential side effects on providers and existing health care markets.