Description: Insurers are becoming increasingly involved in the development and marketing of prepaid health care service plans, or Health Maintenance Organizations HMOs. The article describes four different approaches for establishing capitation rates for HMOs 1. Integrated Budgeting Approach, 2. Inventory Approach, 3. Group Insurance Rating, and 4. Actuarial Approach.

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: Health Care Cost Trends 2002 - prescription drug, base and leveraged trend. From Health Section News, January 2002, Issue No. 42.

Description: This session discussion is about outside actuarial profession's perspective on health care cost, insurer's role in medical care management, relationships between treatment decisions, available coverage, appropriate use of underwriting and paying for uncompensated care. From Record of Society of Actuaries Vol. 18, No. 1A.

Description: This article aims to measure the accuracy of official projections.

Description: The International Actuarial Association Health Section, the Society of Actuaries International Section, and American Academy of Actuaries (AAA) published the report “International Health Care Funding 2020”. This article highlights the features of the report.

Description: Implications of Consumer-Driven Health Care to consumers, employers and providers Issue No. 37.

Description: This article discusses a study of the impact of the drug infliximab on Crohn's disease patients. This study had been approved in response to an SOA request for proposals for research on the health cost and utilization effects of a specific prescription drug.

Description: Social determinants of health (SDoH) have been a topic of growing interest in recent years, yet consensus about what the phrase represents and how health-related social needs should be studied or addressed by employers, health plans, providers and other stakeholders in the business of health care have been lacking. For many, low-income populations come to mind when considering the topic, yet SDoH include a wide range of factors beyond income. Many types of data are available, yet each presents distinct challenges and opportunities for analysis. In this article, we describe some of the underlying context for considering SDoH, as well as some of the potential data sources to consult and challenges to grapple with on this important topic.

Description: Of the three issues in health care—coverage, financing, and cost—the overriding issue is holding down the growth in health care costs while simultaneously improving the quality of care. This article introduces new concepts for reducing cost and increasing quality. From Health Watch, January 2008, Issue No. 57.