Description: This research report provides an evaluation and synthesis of the methodologies and data samples used on characterizing health care fraud.

Description: The SOA’s research objective is to provide guidance to state exchange officials and administrators, federal officials and administrators, and actuaries assisting states and health plans. The goal of the project is to estimate the morbidity and/or cost for newly insured individuals in the individual market (and to some degree, the small group exchange) relative to the morbidity and/or cost for the current commercially insured population. This analysis will primarily focus on the individual, non-group market. In order to plan for the impact that these currently uninsured individuals will have on the health insurance markets, it will be important to understand their costs relative to the costs for people already enrolled, for whom many health insurers have experience and data.

Description: This project shows how to use agent-based models to simulate the behaviors of agents in complex health systems.

Description: The Society of Actuaries Health Benefit Systems Practice Advancement Committee sponsored this review of recent academic literature on the US healthcare system covering quality, access, costs

Description: To look at the impact of the amalgamation of drug price fluctuations, pandemics, and mergers and acquisitions, especially the interaction of them with each other and the overall impact on claims and costs to the company.

Description: The purpose of the SOA project Modeling Long Term Healthcare Cost Trends for Valuation is to provide a benchmark projection of medical cost increases and provide a user-firendly model for making alternative projections. This paper presents sample output from the model, technical documentation of the model, FAQs, and a review of the literature and references.

Description: To identify and quantify the U.S. healthcare insurance disruptors within a five-year horizon.

Description: To provide a quantitative model to identify potential business disruptors and quantify their impacts.

Description: To develop a systematic strategy to identify and predict the financial impacts on pharmaceuticals, physician fees, inpatient services, and outpatient services.

Description: This model arose from a project to evaluate the cost of a health care access' program to provide comprehensive medical care to uninsureds in Minnesota, for the Minnesota Health Care Access Commission. The project was to provide estimates of the impact on per-person and aggregate costs for various participation percentages in the access program. In order to evaluate those costs, the antiselection model described in this was developed. Of note, this was the ACTUARIAL EDUCATION AND RESEARCH FUND 1991 PRACTITIONERS AWARD WINNER. From Actuarial Research Clearing House 1991, VOL. 2.