Sound principles help reform efforts

July 13, 2009

Through access to more robust data, actuaries can help predict and analyze the long-term feasibility of proposed healthcare reform plans.

Actuaries are needed to analyze the feasibility and long-term sustainability of proposed reform plans, according to a collection of essays, ”Visions for the Future of the U.S. Health Care System” by the Society of Actuaries’ (SOA) Health Section.

Managed care executives are interested in sound principles for health reform, according to says Jennifer Gillespie, FSA, MAAA and chair of the SOA’s Health Section, and “how to balance broader access to high-quality healthcare with affordability and a competitively sound private market.”

While most reform is focused at a global level, there are also opportunities for programs, which could be undertaken by an insurer, by an insurer partnering with key providers, or by a community, according to Gillespie.

“Regardless of the environment, healthcare executives should be increasingly focused on evidence-based medicine to improve healthcare quality, appropriate risk-pooling in order to help reduce costs, and improving the quality of healthcare data in order to make efficiencies reality,” she says.

Additionally, the SOA conducted a survey of health actuaries to gauge their thoughts on healthcare affordability, access and quality. Key findings from the SOA health survey include:
• Maintaining affordability of insurance is where employers need the most help in providing healthcare to workers.
• According to 34% of respondents, the highest priority in addressing the issue of healthcare quality was on comparative effectiveness and evidence-based medicine practices being implemented by all providers.
• Thirty-three percent of survey respondents noted that in terms of healthcare access, requiring Americans to buy health insurance was top priority.
• In terms of managing costs, nearly 40% of respondents believed the top priority is reimbursement for providers that use healthcare resources efficiently.