Description: The medical scheme approach adopted by several African countries has failed to meet the needs of those in informal employment and rural communities. This is partly due to affordability amongst these individuals as well as a lack of awareness of how healthcare financing products work. Community based healthcare organisations have achieved greater levels of success in this regard by carefully incorporating the peculiarities of communities in benefit design and involving community members in the management of these healthcare solutions. There are lessons to be garnered from the countries where these have been implemented with some level of success. Even as countries aim towards universal health coverage, observing the unique needs of different communities within a country is essential to ensure resources are utilised efficiently and that healthcare needs are targeted effectively.

Description: A proposal to reform current health care market, from a 'preferred payer' system, in which Medicare and Medicaid pay less than the true cost while others must then pay more, to a 'value for money' system. This would be achieved by requiring providers to bill all patients the same rate for the same services, with a standard bundling format to make all providers' rate differences transparent. Differences between billed charges and what Medicare pays would be made up by the Medicare patient, rather than subsidized by those outside of Medicare.

Description: This article focuses on the capitation rate development methodology for the Medicare-Medicaid Financial Alignment Demonstration. It also describes the background behind the establishment of the initiative and how it will be evaluated.

Description: Developing a formal strategy to guide the SOA’s activities with respect to public policy-related topics is underway. Recent experience shows that non-partisan contributions through the SOA’s research are already adding value to important public policy discussions.

Description: Discusses effect of allowing companies to sell health insurance policy in any state, if approved in one state, without requiring approval in any other state.

Description: Panelists discuss key aspects of recent and pending laws and the cost and design implications on group health plans. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: Discussion of the implications of the newly unveiled health care reform proposal by Senator Baucus. Key issues include abandonment of the CLASS Act, inclusion of LTC in cafeteria plans, funding and tax concerns, individual mandate, privacy concerns, play-or-pay employer mandate, impact on Medicare and Medicaid, and gridlock in the legislative finalization process.

Description: Updates on the efforts of the Academy’s health practice council. its work groups and task forces, to educate health care policymakers on issues including principles for reform, Medicare, the individual insurance market, and risk factors.

Description: Health care reform will require health insurers to change the way they make decisions on what to sell while remaining financially sound. The new regulatory reality of expanded access to coverage leaves insurers with fewer options for managing costs and business risk. With the introduction of risk adjustment mechanisms in the exchanges, the most profitable members will not necessarily be the lowest cost ones, but rather, the members which the health plan is relatively more effective at servicing. While Patient Protection and Affordable Care Act 'PPACA' prohibits underwriting and using any health status information for denying coverage or varying the premium rates, this article describes how the use of consumer data will affect the way health insurers make decisions on what products to sell.

Description: A summary of concerns about the Community Living Assistance Services and Supports Act, including flaws in the underlying premises, opportunism, inadequate sales incentives, insufficient benefits, adverse selection, and cashflow and solvency issues.