Description: This session is about the details of the inception and implementation of the Oregon Health Plan. From Record of Society of Actuaries Vol. 18, No. 1B.

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.