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 article compares three potential approaches to determining new coefficients for health-based risk scoring models: full recalibration, p-value credibility weighting, and penalized ridge regression.

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: The Behavioral Finance subgroup of the Health Section will be publishing a series of literature reviews in Health Watch. This is the first review of three in the series. The reviewed article describes an attempt to place an econometric value on consumers’ preferences between broad and narrow networks.

Description: In 2007 the International Accounting Standards Board IASB released a discussion paper proposing a new accounting model for insurance contracts, known as the current exit value model. One aspect of the proposed accounting model is that claim liabilities would need to include explicit margins satisfying certain criteria. Currently it is common for U.S. medical insurers to include explicit margins in their claim liabilities. However, we demonstrate that the margin approach most commonly used today by U.S. medical insurers does not satisfy the objectives articulated in the IASB discussion paper regarding the role of margins. We then propose a new formula for including explicit margins in U.S. medical insurance claim liabilities in a manner that is more compatible with the principles articulated in the IASB discussion paper. Finally, we illustrate our proposed claim liability formula using an example drawn from real-life data.

Description: Actuarial appraisal and role of the actuary with regards to Health Insurance Mergers and Acquisitions. Issue No. 40.

Description: Hospitals, through consolidation and affiliations, gaining back negotiation strenght lost due to managed care in the 80s and 90s. Charges vary significantly by area and facility. Issue No. 46.

Description: This report compares health care utilization and expenditures between individuals with Crohn’s disease who had used infliximab and those who had not. Claims data from the 1999-2003 Thomson Reuters MarketScan commercial claims and encounters databases and inpatient, outpatient, and prescription drug claims data of individuals older than 18 years of age with a diagnosis of Crohn’s were included.

Description: This article overviews the results of the 2008 survey of Third Party Administrators of Employer Stop Loss business.