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: A proposal to address provider payment issues by gradually moving to accountable care organizations. Capitations would be risk-adjusted, non-capitated costs would be covered by hospitalization fund and stoploss, incentives for quality & effective preventive care would be tied to the amount remaining in the fund, and government involvement would be through incentives rather than mandate.

Description: Feature article from the January 2010 issue of In The Public Interest discussing the need for actuarial leadership in the reform of the U.S. health care system.

Description: The chairperson reports on Health Section activities: papers by the joint workgroups with the AAA's Health Practice Council to inform the public and congressional staff, papers on capital requirements under proposed health care reform and on proposed taxing of Cadillac plans, new research on IBNR reserving methods and on measuring the quality and efficiency of health care delivery systems.

Description: This article includes a summary of 2012 Health section activities as well as upcoming events, including the Health '12 Meeting, two HARI research projects (ACOs and risk adjustment), the value of health section membership, and our Canadian Outreach.

Description: This session is about the Health insurance has become an important issue in this year's presidential election campaign. What effect will this have on the likelihood of major health-care reform, on public expectations about rights to health care, about perceptions of health insurers, etc? From Record of Society of Actuaries Vol. 18, No. 4A.

Description: Rhode Island’s unique “global Medicaid waiver” pursues a potentially dangerous national policy trend: long-term care LTC rebalancing without strong eligibility controls. Resulting cost overruns could seriously damage the state’s social safety net. To maximize the global waiver’s opportunity, minimize its danger, and become a LTC financing model for the country, policy makers need to recognize the issues discussed in this report and pursue the recommended additional research and analysis.

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: Letter by Concerned Actuary Group, printed in the January 2010 issue of In The Public Interest, in response to August 6 Review and Outlook Section editorial titled “Obamacare’s Real Price Tag.”

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.