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: This article discusses the growing number of cases of dementia and its effects on economics and loved ones.

Description: A proposal to address provider payment issues by gradually moving to accountable care organizations. Capitations would be risk-adjusted, non-capitated costs would be covered by hospitalization fund and stoploss, incentives for quality & effective preventive care would be tied to the amount remaining in the fund, and government involvement would be through incentives rather than mandate.

Description: Overview of the book: Overtreated, Why Too Much Medicine Is Making Us Sicker and Poorer.

Description: An examination of the underlying reasons for the concept of health expectancy, some alternative approaches to developing the measurement and some of the powerful uses of this new tool.

Description: A look back at the 30 years since the Health Section was formed.

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: This article talks about the new onsite clinic at Hewitt and how it benefits employees and employers.

Description: A rethinking of current provider reimbursement, focusing on incentives instead of simply cutting fees. The recommended 2-pronged approach would feature integrated provider organizations as well as evidence-based decision making organized around episodes of care.

Description: The Health Section Council Chairperson looks back at a historic year for the health care industry, and what it means for health actuaries.