The health reform bill and changing demographics are helping drive carriers' offerings and strategies.

Presentation from the SOA '10 Health Meeting, held on June 28–30, in Orlando, FL.

Diabetes is a major health cost driver, and people with the condition are at higher risk for developing severe complications. The authors' modeling indicates that a 50% improvement in type 2 diabetes management would have immediate positive results, and in 20 years would lead to a lower rate of diabetes-related complications and deaths as well as a reduction in associated medical costs.

The state healthcare exchanges that will be created as part of the Patient Protection and Affordable Care Act are intended to bring buyers and sellers together in a single marketplace for qualified healthcare insurance. While the idea of a single marketplace is relatively straightforward, there are numerous underlying complexities, including plan cost, affordability, access, group size, participant age, marketing and education, eligibility, plan qualification, and risk adjustment. States that plan to establish exchanges should be well aware of these issues and should determine the best course of action depending on their specific circumstances.

Presentation from the SOA '10 Health Meeting, held on June 28–30, in Orlando, FL.

Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to three earlier editions—includes data from seven countries and incorporates patients' and physicians' survey results on care experiences and ratings on dimensions of care. Compared with six other nations—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. Newly enacted health reform legislation in the U.S. will start to address these problems by extending coverage to those without and helping to close gaps in coverage—leading to improved disease management, care coordination, and better outcomes over time.

KPMG article is focused exclusively on the individual health insurance market and the reform-stimulated change that is expected.

The fourth in a series about global health-care issues, looking at how aging populations will impact health-care systems and social policies across the world. This article focuses on Hong Kong.

More than a year after the enactment of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), the Departments of Labor, Health and Human Services, and Treasury issued interim final rules (IFR) prohibiting group health plans and insurance from applying more restrictions on mental health or substance use disorder benefits than they do for medical/surgical benefits. In the absence of formal guidance until the publication of the IFR and with the MHPAEA requiring compliance for plan years starting on or after October 3, 2009, many group health plans have been operating under a good-faith compliance standard. The IFR from the federal agencies provides significant guidance in some areas, and several of the requirements will necessitate additional steps to ensure compliance. Understanding how the IFR may affect the business of behavioral healthcare and the decisions that follow will be of great importance to all interested parties, including health insurance companies, health plans, employers, providers, and consumers of behavioral healthcare.

While most of the regulations necessary to implement healthcare reform have yet to be issued, it is clear that the health insurance industry will face a new layer of regulatory complexity. Health plans will be more heavily scrutinized at both the state and federal levels.

This paper outlines the scope of the changes facing health insurers in the individual, small group, and large group markets.

Intensive care patients who did not have health insurance were 21 percent more likely to die than insured patients, U.S. researchers report.

2010 healthcare costs increase $1,303 for family of four.

Charting provided by The Commonwealth Fund.

States will play a major role in creating interim high-risk pools, controlling health insurance rates and managing other health reform implementation efforts, according to Kathleen Sebelius.

Also see HHS Secretary Sebelius Sees More Combat With Insurers.

In standard medical benefit designs, intravenous/injected chemotherapy drugs are usually covered through medical benefits, while oral chemotherapy drugs are covered through pharmacy benefits. Some pharmacy benefit designs require unlimited cost sharing and thus can make high-cost oral cancer treatment medications unaffordable. This report examines the concept of creating parity between oral and intravenous drugs by equalizing patient cost-sharing for all chemotherapy drugs, and also addresses the cost implications of proposed drug parity legislation.

Health care reform legislation—the Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act—includes numerous provisions to expand access to health insurance, improve the quality and comprehensiveness of coverage, and make coverage more affordable for all Americans. This timeline from The Commonwealth Fund outlines when the various health insurance provisions will go into effect; click on the dates to see the provisions that will be implemented during that year.

Article in the Society of Actuaries Health Watch Newsletter - February 2010, starting on p. 28.

Raymond Yeung looks at the new health reform in China and its implication on the development of Chinese health insurance industry.

In this guest editorial for The Geneva Association's Health and Ageing newsletter, Howard Gleckman reviews the current long-term care financing model in the U.S., as well as several potential alternatives, including the CLASS Act.

From The Commonwealth Fund Charts.

With health care costs increasing at six percent per year for the next decade, and medical tourism offering savings of up to 70 percent after travel expenses, the Deloitte Center for Health Solutions estimates that the medical tourism industry will recover from the current economic downturn and attain 35 percent annual growth in coming years. This growth holds important implications for U.S. health care providers, health plans, consumers and the government.

A new study, “Medical Tourism: Update and Implications,” updates the Center’s 2008 report on the industry and examines the many factors that have influenced the growth and regulation of patients traveling for medical care, including Washington’s search for ways to control the country’s soaring health care costs. This timely study already has generated coverage by news media, including the Associated Press and USA Today.

This interactive U.S. map draws from The Commonwealth Fund State Scorecard, 2009. Use the map to view state-specific rankings and results compared to benchmarks, and to view the number of lives and dollars each state could save by achieving benchmark levels of performance. Use the tool on the right to select years, performance indicators, and states for comparison and then generate custom, downloadable tables and bar charts.

As the recession takes its toll, what are organizations in Europe doing to manage cost while supporting their employees in looking after their own most important asset – their health? (Mercer)

Cost management, which took a back seat in Canada during the heady days of the last decade, is back. Although benefits still represent a small percentage of payroll, given the country’s accompanying medicare system, Canada was not immune to the effects of the global economic recession. Plan cost management is now a priority. Short-term economic survival is the imperative – long-term financial stability and affordability is the goal.

A senior executive in the German Ministry of Health describes approaches the country is using to control health care costs in this McKinsey Quarterly article.

An analysis of insurance and financial stability from The Geneva Association Systemic Risk Working Group.

Personalized medicine promises to increase the quality of clinical care and, in some cases, to decrease health care costs. The biggest hurdles are economic, not scientific.

In order to launch new health microinsurance products, actuaries and other healthcare professionals will be involved at the pricing stage as technical advisors. This Milliman paper provides technical advisors with some guidelines and a tool for collecting healthcare pricing data where none exists or where what exists is unreliable. These tools are provided to the reader as a set of appendices.

Actuaries bring a crucial and unique perspective to the health care reform dialogue. The role of the American Academy of Actuaries' Health Practice Council is to bring that actuarial perspective to the attention and aid of policymakers through the introduction of a new series of policy statements: Critical Issues in Health Reform. On this page you’ll find links to each of those informative statements, as well as other thought-provoking pieces on the wide-ranging subject of health care reform.

This Commonwealth Fund survey finds an overwhelming majority of young adults think it is important for Congress and the President to pass health reform legislation. The survey found that nearly half—45 percent—or approximately 20 million young adults between the ages of 19 and 29 were uninsured at some time during the past year.

Statistics show an encouraging pattern of increased life expectancy that will trigger increased consumption patterns in the population for medical services and pharmaceuticals, says this Milliman Pharmaco-Actuarial Advisor article.

In an effort to get its healthcare reform legislation back on track, the Obama administration today issued a report maintaining that insurer premiums will continue to skyrocket without reform.

America’s Health Insurance Plans reacted swiftly.

Several of the reform bills in Congress share a common theme: A move away from the rating and underwriting techniques that are used to manage adverse selection, and a move toward an individual mandate where all people are required to obtain health insurance. This paper by Thomas D. Snook and Ronald G. Harris will focus on these reforms, and how adverse selection will impact premiums rates in the post-reform world.

CIGNA has released the findings of a new study that reveal an unmistakable trend: Integrating disability with health care programs has the potential to lower employers' total benefits costs and help disabled employees get back to work sooner and stay at work. As a result of the positive results found in the study, CIGNA is lowering its prices on disability benefits purchased with CIGNA medical coverage.

Essays on healthcare reform from the Society of Actuaries.

Most proposals for reforming the U.S. health care system of today focus on reducing the high cost of care. The standard thought process assumes that reducing costs will increase access to care by improving the affordability of health care and perhaps funding more care for the uninsured. An endless number of proposals focus on this issue. In fact, most of today’s initiatives are based upon lowering costs and/or “bending the trend.” Too few proposals address the core of this essay, “How do we capture those savings?”

The term 'medical tourism' seems to be cropping up everywhere these days. From trade and business journals to the popular press, traveling to another country specifically to obtain medical care is a significant new trend. In this challenging economy, where the cost of healthcare continues to spiral up and hundreds of thousands have lost their health insurance along with their jobs, it's not surprising to see keen interest in less expensive resources, especially because the savings are often substantial.

Among the components of the Baucus plan for healthcare reform: Interstate Sale of Insurance: Starting in 2015, states may form “health care choice compacts” to allow for the purchase of non-group health insurance across state lines. Insurers selling policies through a compact would only be subject to the laws and regulations of the state where the policy is written or issued. More on the Baucus plan...

QuickStats from the CDC's Morbidity and Mortality Weekly Report.

You can check out the latest on the global spread of influenza here.

Presentation at Institute of Actuaries Australia 2009. (Audio, slides and synopsis available.)

Current instability in the financial markets has many wondering if a systemic failure could happen in other industries. American International Group’s (AIG) difficulties shifted the spotlight toward the insurance arena. Those that wish to see the insurance industry regulated on a national level are using the current economic crisis as an opportunity to revisit insurance reform legislation. Just last week, Therese Vaughan, chief executive officer of the National Association of Insurance Commissioners (NAIC), gave testimony before the U.S.

From the March 2009 issue of Gen Re's Risk Insights.

According to the Business Roundtable Health Care Value Comparability Study, a new measure of the “value” (cost and performance) of the U.S. health care system relative to our competitors’ systems on a weighted scale, the workers and employers of the United States face a 23% “value gap” relative to five leading economic competitors and a 46% “value gap” compared with emerging competitors.

Assessment tools that assign risk scores to insureds—or potential insureds—based on their prescription histories are increasingly used by actuaries and others within health insurance organizations to assess future health risk.

'Risk' is a term that comes up frequently when people discuss medicine and health: What's my risk of heart attack? Breast cancer? What's my risk of dying from a complication of surgery? Or having a dangerous reaction to a drug?

But according to Mark V. Pauly, Wharton professor of health care systems, consumers don't necessarily use that term in the same way that medical and insurance experts do -- which is a potential pitfall that can lead to less than optimal health care decisions and faulty policymaking.

More Americans will lose their health insurance as the economy weakens, health care becomes more expensive and fewer employers offer coverage, the U.S. Institute of Medicine said in a report on Tuesday.

A.M. Best Co. recently completed its annual review of public data (pd) financial strength ratings (FSRs) for health maintenance organizations (HMOs). A.M. Best has upgraded the FSRs of 21 HMOs, downgraded 19 HMO FSRs, affirmed 107 HMO FSRs and assigned seven HMO FSRs.

Presentation by Kathy Thomas at the SOA Individual and Small Group Health Insurance Underwriting Seminar, September 2008.

Presentation by Tia Sawhney at the September 2008 SOA Individual and Small Group Health Insurance Underwriting Seminar.

Presentation at the SOA Annual Meeting & Exhibit, October 2008.

Without underwriting, individual coverage applicants on average cost 40% more than applicants for small group coverage. While the individual market provides insurers more opportunities to take rating actions and to improve their competitive positions, it also presents more risks than group insurance since individual health insurance applicants are collectively less healthy and have greater variance in their claim costs than applicants in other markets. For these reasons, the individual market is especially susceptible to adverse selection.

June 2008 – Around 70 representatives of primary insurance companies from all over Europe, and some from further afield, came together on 23 – 24 June 2008 at the Swiss Re Centre for Global Dialogue for a packed agenda of presentations, discussions and networking. Leading expert key note speakers addressed delegates, together with senior management from Swiss Re. All were focused on a single theme – growth opportunities, together with their accompanying risks, for life and health insurance markets in Europe.

According to a recent Associated Press review of agency programs, the Environmental Protection Agency (EPA) values an American life at $6.9 million-a figure that environmental advocates point out is actually 11% lower than it was five years ago.

Executives should treat them as programs, not products. Article from the McKinsey Quarterly (registration required - free).

Attached is a letter that Tia Goss Sawhney wrote to America's Health Insurance Plans regarding research reports that they published in 2007 and 2005. For reasons detailed in the letter, Sawhney feels that the reports do not give our government leaders and members of the public the quality information that they need as we engage in healthcare debate.