Description: This analysis provides an overview of the functional components of the managed care system. It discusses the market forces underlying the United States’ system for health care financing and delivery and suggests how market forces impact the health care industry. The analysis focuses on societal goals for health care delivery and on managed care’s effectiveness in enabling achievement of those goals. The analysis develops and uses an innovative model developed to summarize the complex interplay among the many stakeholders, or participants, in the health care system. The model provides a framework for analysis of the many relationships among stakeholders. The analysis also highlights current issues in managed care, particularly the barriers that impede collaboration among stakeholders.

Description: CHCS is a nonprofit policy center focused on improving American health outcomes, particularly for low-income people, including payment & delivery system reform.

Description: letter from the editor, she introduces herself and her role as a consultant.

Description: The SOA Long-Term Care Experience Committee (LTCEC) will be conducting a study on a) incidence, lapse and mortality study and b) claim terminations.

Description: On January 1, 2014, many states will be enrolling newly eligible parents and childless adults into the Medicaid program. This article compares the expansion population to the current Medicaid population.

Description: This article introduces a research report that studied the relationship of nontraditional variables with health costs.

Description: This final report is a SOA Task Force response to a NAIC request to develop valuation recommendations for long-term care insurance. Two basic sets of tables are provided: one for institutional benefits [nursing home] and one for noninstitutional benefits [home health care]. From Transactions of Society of Actuaries 1995, Vol. 47.

Description: This session discussion is about nonforfeiture values for long-term care: valuation of different approaches [cash surrender value, return of premium, reduced paid-up, extended term, shortened benefit period], sensitivity testing, implications for marketing and regulatory status. From Record of Society of Actuaries Vol. 19, No. 1A.

Description: Panelists at this session of the SOA 2000 Las Vegas Spring Meeting discuss proposed changes to the NAIC model for Long Term Care Insurance designed to promote initial rate adequacy and decrease the role of rate increases in maintaining profitability.

Description: This session discussion legal liability for unfavorable medical outcomes, effect of utilization review on the quality of care and patient/provider acceptance, protocol development and implementation for managed care, and insurance coverage necessary to protect your organization. From Record of the Society of Actuaries 1987 Vol. 13, No. 1.