Description: Presented at September 1994 Valuation Actuary Symposium. Discusses analyzing and projecting financial risk in group health plans.

Description: Presented at October 1985 Annual Meeting. This session is about actuarial implications of individual choice, antiselection problems for medical coverages, plan design considerations, flexible benefits program experience, impact of alternative delivery systems on insured plan.

Description: Report from research project that reviewed and inventoried the range of quality and efficiency measures that demonstrate the performance of hospitals and physicians. Besides outlining key areas of consideration for quality and efficiency measurement, this report also describes future opportunities for actuaries and other health professionals interested in this evolving area. The inventory part of the report is in a separate document.

Description: Panelists discuss different aspects of self-selection among Medicare options. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: A new health insurance pricing model takes external market prices into account, as well as regulatory rate restrictions and other traditional pricing factors. Rather than being assumed at the outset, lapse rates emerge from the model, along with assessment spiral & loss ratio projections. Under the model optimal pricing strategy depends on whether the class being rated has a healthier than average mix of risks.

Description: In an effort to build a bridge between epidemiological and actuarial modeling, this paper analyzes possible financial arrangements made against expenses resulted from medical treatments given to insured patients. Based on classical compartment models, the first part of this paper designs insurance policies for susceptible participants facing the risk of infection and formulates the financial obligations of both parties using actuarial methodology. For practical purposes, the second part employs a variety of numerical methods for calculating premiums and reserves. The last part illustrates the methods by designing insurance products for the Great Plague in Eyam and the SARS Epidemic in Hong Kong.

Description: The article looks at potential changes in care provider demographics that could ultimately have an impact on the cost of long term care services.

Description: Panelists discuss their practices and experiences implementing risk measurement and management for various health insurance product lines including disability income, long-term care, medical/managed care and group insurance products. From Record of Society of Actuaries, Vol. 30, No. 1., Session 65

Description: Research project that reviewed and inventoried the range of quality and efficiency measures that demonstrate the performance of hospitals and physicians. Besides outlining key areas of consideration for quality and efficiency measurement, this report also describes future opportunities for actuaries and other health professionals interested in this evolving area. The inventory part of this report is in a separate document.

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