Description: This article is a recap of the study conducted by Milliman surveying 20 small group carriers on their renewal methods. The article covers: study methods, study results, analysis on carrier data, and competitive simulations. From Health Section News, August 2005, Issue No. 50.

Description: The Behavioral Finance subgroup of the Health Section will be publishing a series of literature reviews in Health Watch. This is the first review of three in the series. The reviewed article describes an attempt to place an econometric value on consumers’ preferences between broad and narrow networks.

Description: From the April 1982 Society of Actuaries meeting in Houston. Discussion of how the insurance industries in several countries have dealt with high levels of inflation with respect to the development and marketing of insurance products. Also discussed: I. the overall business and economic environment 2. the taxation structure of insurance companies 3. the availability of suitable investments 4. the insurance regulatory climate and 5. the structure of worldwide capital markets Possible applications to U.S. insurance in the 1980's were explored.

Description: This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for fraud detection in Medicare.

Description: Mining Electronic Health Records using a Natural Language Processor.

Description: Read the February 2018 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: How benchmarking actual performance to a published source is a useful tool in assessing the value added by a particular program or MCO, Issue No. 38.

Description: Traditional methods of addressing reserves and liabilities have failed to cope with the problems of escalating claim costs, frequent rate increases, and different opinions as to what liabilities should be recognized. This paper reexamines these issues, discusses shortcomings of current methods and proposes a new approach to the total subject. From Transactions of Society of Actuaries 1985, Vol. 37.

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.