IAAHS Section

Leaders: Lisa Morgan, Willem C. Claasen
The purpose of this Project Team is to highlight existing and new digital solutions to assist with the delivery of health programmes. This is particularly important for inclusive health insurance plans (also known as microinsurance), where margins are thin and target populations may be remote, but is also of interest to conventional private health insurers and large scale government health programmes that want to take advantage of the efficiencies and savings that digital solutions could deliver. Digital solutions, in this context, include all elements of digital technology that can assist with the health coverage value chain

Leaders: Shereen Sayre, Lisa Morgan
To identify, describe and compare public and private sector healthcare models to provide medical care to their target populations as well as the interaction between the public and private sectors in helping consumers of medical services finance healthcare costs at macro and micro levels.

Leader: Yoobin Choi

Project name: Inflation’s Impact on Global Healthcare Costs Across Funding Models

This project aims to develop a generally applicable framework for actuaries to model the effects of inflation on healthcare trend & expenditures. This retrospective study will examine the relationship between general inflation and healthcare inflation, considering diverse healthcare systems and funding mechanisms globally. Select countries from a range of funding mechanisms (such as largely public, largely private and mixed) will be used as case studies.

Leader: Kevin Manning
This Project Team considers the existing capital models in health insurance and the role of the actuary in health risk capital. This includes evaluating the main challenges with health risk capital models or with the current understanding of health risk capital and defining a priority list of issues. Where appropriate, the Project Team will also make recommendations for actuaries and help to define the use test.

As far as risk management (or more particularly enterprise risk management (ERM) in health care is concerned, the Project Team will also consider existing frameworks, the role of the actuary and the main problems encountered in health risk management frameworks.

Leaders: Pedro Pacheco
In reviewing the existing medical expense products (i.e., indemnity cover for health expenses), this Project Team investigates such matters as the relationship between private and social health insurance cover, the role of the actuary in medical insurance products, and the main problems that actuaries encounter in their work in this field. Product development, pricing, managed care and valuation are areas of enquiry for this Project Team.

Leaders: Luis Maldonado
This Project Team studies how health care expenses are measured across different populations, geographies, and program designs, using various data driven techniques, such as risk assessment and risk adjustment. Program design differences incorporate not only which health care expenses are covered in a program, but also how they are provided so that process and model efficiencies are also addressed. In addition, the Risk Adjustment Topic Team also investigates how risk equalization programmes are implemented across the world, and the techniques of quantifying the extent to which one insured group represents a higher or lower risk than another. Further, the techniques of clinical risk adjustment, such as diagnosis related groupers and medical staging, are also within the ambit of this Project Team.