Description: Analysis of possible mathematical relationships between hospital quality and hospital billed or allowed charges or other measures, using quality data as defined by the U.S. Department of Health and Human Services along with the Hospital Quality Alliance for their Hospital Quality Initiative.

Description: This paper explores the legislation of Mass 65, the intent of which was to offer health benefits to persons aged 65 and older without evidence of insurability. From TRANSACTIONS OF SOCIETY OF ACTUARIES, 1962 VOL. 14 PT. 1, NO. 40.

Description: Discussion of accident and sickness policies, including issues with underwriting and points for improvement. Transactions of SOA Vol. 6 No. 16

Description: The principal objective of this paper is to remind actuaries of the rather significant misconceptions and distortions commonly encountered in the use of individual accident and health insurance loss ratios. From Transactions of Society of Actuaries 1979, Vol. 31.

Description: Using data from the Health & Retirement Study [HRS], a two-part medical claim prediction model is estimated for a cohort of survey respondents approaching Medicare-eligibility age. A High Deductible Health Plan [HDHP] with a companion Health Savings Account [HSA] is applied to simulated claims streams to model the build-up of HSA assets over the near-retirement years. Results show that the HSA is a grossly inadequate savings vehicle to provide for retiree medical care expenses at age 65. Moreover, HSA adequacy worsens exponentially with diminishing health status. Based on this simulation, it is apparent that Baby Boomers cannot adequately provide for the costs of medical care in retirement using HSAs exclusively.

Description: Discusses how a small health insurance company may be able to create and successfully maintain its wealth through careful actuarial model considerations used in calculating reserves. A traditional and a conservative approach to calculating the reserves are compared. The conservative approach was found particularly useful when estimating reserves for an individual health insurance company with numerous product lines each relatively small in volume.

Description: This paper applies the principles and methodologies discussed in earlier papers in this series to measure cost savings from a two-year disease management DM program for the 200,000 Medicare members of a regional managed care plan. We then study how savings estimates change when we allow for four variations in key assumptions: methods for identifying or excluding plan members, requirements for eligibility in the health plan, methods for calculating health care trend and study design. Finally, we also examine the sensitivity of these results to product type by comparing the Medicare results to those of the Commercial HMO/POS product. Paper 8 of an 8 paper series titled: “Evaluating the Results of Care Management Interventions: Comparative Analysis of Different Outcomes Measures” sponsored by the Society of Actuaries’ Health Section and the Committee on Knowledge Extension Research.

Description: This report aims to expand our understanding by providing a methodology to quantify uncertainty in risk assessment.

Description: The purpose of this paper is to analyze several existing versions of the return of premium provision and to attempt to develop a logical critique of the concept, with the object of suggesting certain criteria [cost, equity, and compatibility with the purpose of the basic coverage of the health contract] which could serve as a basis for evaluating the merits of various forms of the provision. From Transactions of Society of Actuaries 1970, Vol. 22, Pt. 1, No. 64.

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.