Description: This report pulls together various findings on long-term care research from the 2017 Risks and Process in Retirement Survey as well as other SOA research.

Description: This SOA report describes the components of margin for calculating capitation rates in a Medicaid context along with practical issues that MCOs may face.

Description: The paper traces the history of government-sponsored hospital and medical care schemes from their beginnings in the Prairie Provinces prior to World War I to the present day. Particular attention is paid to the Health Charter for Canadians. From Transactions of Society of Actuaries 1982, Vol. 34.

Description: Accurate forecasts of future health care expenditures for cohorts of elderly individuals can be especially difficult. Current techniques use average per capita costs, based on local experience, adjusted for the cohort's age, sex, institutionalization, and welfare status distribution. This paper presents a method to adjust such per capita cost estimates to reflect more accurately the likely health status of a particular cohort. The adjustment uses the cause-of-mortality profile in the local population, which is a readily available tabulation known to be highly correlated with a major proportion of total medical care expenditures for people beyond age 65. From Transactions of Society of Actuaries 1984, Vol. 36.

Description: This report estimates sex-specific trends in HIPAA ADL disability between 1984 and 2004 using the National Long Term Care Survey (NLTCS); estimates age-standardized 20-year changes in ADL and cognitive impairment (CI) among the U.S. elderly using the HIPAA CI trigger; estimates the joint distribution of cognitive impairment (CI) and ADL disability among aged Medicare enrollees using the HIPAA disability triggers.

Description: This paper helps the audience understand the actuary’s role in estimating the financial impact of primary care programs. In addition, the paper can be used by actuaries to think about key issues when estimating the financial impact of their employers’ and clients’ own primary care programs.

Description: A study of whether tobacco, area and industry rating in one state may be reflecting unintended factors such as race, ethnicity or socioeconomic status. This study does not consider whether the rating factors accurately reflect underlying claims costs.

Description: This report explores two LTC insurance product concepts. The concepts were developed as part of an effort to create innovative new LTC insurance products.

Description: This research report that provides a literature survey of methodologies applying machine learning to insurance claim modeling.

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