Description: Discussion of the impact of the ACA on RBS and required surplus for a health plan

Description: This article is focused on sustainability concerns in the ACA individual markets and what we can learn from core actuarial principles as discussed in ASOPs.

Description: This research report is sponsored by The Society of Actuaries and the Canadian Institute of Actuaries on the Canadian health care system. Performed by Stéphane Levert, FSA, FCIA, the study (available in French and English) estimated the future costs of the Canadian health care system, assessed the sustainability of the system over a 25-year horizon, and analyzed the implications of the changes to the Canada Health Transfer proposed on Dec. 19, 2011 by the federal government. The report summarizing the findings indicates that, without significant government intervention, the Canadian health care system in its current form is not sustainable.

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: A call for papers on health insurance topics to enhance the program for a 1979 special topic meeting of the Society of Actuaries.

Description: Established as part of the 1998 Utah State legislative session, the State of Utah's Children's Health Insurance Program CHIP delivers much-needed health insurance to children that are not eligible for Medicaid and who are below certain poverty levels. From Prescription Drugs Monograph, M-HB04-1.

Description: This article talks about the new onsite clinic at Hewitt and how it benefits employees and employers.

Description: Insurers are becoming increasingly involved in the development and marketing of prepaid health care service plans, or Health Maintenance Organizations HMOs. The article describes four different approaches for establishing capitation rates for HMOs 1. Integrated Budgeting Approach, 2. Inventory Approach, 3. Group Insurance Rating, and 4. Actuarial Approach.

Description: A rethinking of current provider reimbursement, focusing on incentives instead of simply cutting fees. The recommended 2-pronged approach would feature integrated provider organizations as well as evidence-based decision making organized around episodes of care.