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Actuaries Weigh in on Ways to Address Risk Exposures and Challenges with the U.S. Health Care System
Date:6/11/2009

SCHAUMBURG, Ill., June 11 /PRNewswire/ -- Many interested parties and organizations have provided recommendations on U.S. health care reform, but there is much to be done in terms of mapping out its future. As leading health care professionals, actuaries are looked to for their points of view on this important topic. Providing new health insights, the Society of Actuaries' Health Section has published a collection of 29 essays from actuaries, health care professionals and academics titled, "Visions for the Future of the U.S. Health Care System." The essays cover a wide array of health care issues, but there are four underlying angles: general reform and restructuring of the health care system; risk pooling and risk-adjusted payments; evidence-based medicine and more efficient cost/care.

In an essay on general health care reform, David Axene, FSA, FCA, MAAA, president of Axene Health Partners LLC, noted, "Today there are more than 45 million uninsureds in the U.S. With the challenging economy and increased job loss the number of uninsureds is expected to increase. It is in our country's best interest to minimize the number of uninsureds..." Axene brought attention to the need for general reform to include the entire U.S. population - not just those with health care insurance, to help bring balance between spending and debt. He added, "Everyone's cost to obtain health coverage should go down if more people are covered by some form of a health benefit plan just from the reduced write-offs of health care providers."

Focusing on new ways to pool risk within health care, Thomas Persichetti, ASA, MAAA, consulting actuary at Persichetti & Associates, LLC, wrote, "The question should be asked, is it possible to restrict the role of health insurance to only those individuals that meet the definition of an insurable risk?... One possible solution is to establish a national high risk pool and enroll everyone with one or more chronic conditions in it... The goal of the program would be to ultimately reduce the costs of care for the chronically ill by one-third."

In his essay on the need for evidence-based medicine, John Cookson, FSA, MAAA, consulting actuary at Milliman Inc., discussed how "consumers must be made more responsible for their own care, and they must be provided the tools and information to choose wisely. The providers must then adapt to the new realities by becoming more efficient and improving quality." This supports the overall need for results-driven medicine and procedures, which is a similar approach to risk management for corporations.

Focusing on the need for more universal access to data, Dale Yamamoto, FSA, MAAA, EA, FCA, president of Red Quill Consulting, stated in his essay, "Creating a national data warehouse will facilitate the ability for actuaries and other analysts to have access to more consistent data from all health plans to better understand their ability to manage health care utilization."

Each of the 29 essays support one of the four key angles, emphasizing the roles that actuaries can play with health care reform. Chair of the SOA's Health Section, Jennifer Gillespie, FSA, MAAA, said, "Through access to more robust data, actuaries can help analyze the feasibility and long-term sustainability of proposed plans. That insight can help aid in understanding where the past problems were and how to best mitigate these risks in the future."

In conjunction with the release of the essays, the SOA conducted a survey of its health actuaries to gauge their thoughts on health care affordability, access and quality. Out of nearly 300 survey respondents, 39 percent believed that one of the most important roles that actuaries can play in the health care debate is to invest in quantitative research to quickly evaluate proposals for reform.

The other key findings from the SOA health survey include:

  • The highest priority in addressing the issue of health care quality, (34 percent of respondents) was on comparative effectiveness and evidence-based medicine practices being implemented by all providers. The second highest response was on the need to align provider reimbursement with outcomes.
  • The survey respondents noted that in terms of health care access, requiring Americans to buy health insurance was the top priority (33 percent), followed by the need to make all insurance portable.
  • In terms of managing health costs, nearly 40 percent of respondents believed the top priority is aligning reimbursement for providers with efficient use of health care resources. Managing utilization, especially new medical technology and products, was the second highest response, followed by reducing the impact of public sector cost shifting.
  • Maintaining affordability of insurance is where employers need the most help in providing health care to workers, according to the survey respondents.

Gillespie said, "With our expertise and rigorous training in risk management, insurance and longevity, actuaries are well-equipped to work with key stakeholders in finding a new viable solution for the challenging health care crisis."

For the full health care essay collection, "Visions for the Future of the U.S. Health Care System," visit www.soa.org\healthessays.

About Actuaries

Actuaries bring a complex future into focus by applying unique insight to risk and opportunity. Known for their comprehensive approach, actuaries enable smart, more confident decisions.

About the SOA

The Society of Actuaries (SOA) is the largest professional organization dedicated to serving 20,000 actuarial members and the public in the United States and Canada. The SOA's vision is for actuaries to be the leading professionals in the measurement and management of financial risk. To learn more, visit www.soa.org.


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SOURCE Society of Actuaries
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