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: This is the abstract for the paper, Measuring DM Program Outcomes: The Use of Incident and Prevalent Populations by Ying Liu, MS and Michael Cousins, PhD.

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: This is the abstract for the paper, The Boomers Are Coming: A Total Cost of Care Model of the Impact of Population Aging on the Cost of Chronic and Acute Conditions in the United States. The complete paper is not available online.

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: 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 health care reform, Medicare, loss ratios, premium review, reinsurance, benefit and eligibility changes, exchanges, and risk based capital.

Description: This discussion reviewed: A. Measures used by smaller companies to deal with below average policy persistency rates, B. The extent to which smaller companies issue policies with little to no retention for their own accounts, C. The extent to which new lines of insurance, such as accident and sickness, and changing distribution of business by line, plan, or age, have caused reconsideration of qualification bases for agency convention and honor awards.

Description: This monograph explains the ways actuaries are or could be involved in the self-insured employer health plan marketplace today and in the future.

Description: Report on the activities of the Academy’s health practice council and its work groups.

Description: Recap of Health Section's 2014 events and member survey.