Reinsurance Flashcards
(10 cards)
Contingent loan
Is directly proportional to the value of the future profits contained in a ablock of business
Rather than current assets or collateral
With repayment of the loan being contingent on those future profits
- may have certain conditions attached to it - such as min profit levels , maximum repayment period, that could affect the ultimate befit to the insurer
- the cedant may not need to reserve for the repayments within its supervisory returns given the contingent nature
- therefore, insurer experience an increase to its assets equal to the size of the loan and no corresponding increases in liabilities - resulting in an improved solvency position of the insurer.
Risk-adjustment - case mix adjustment
Case mix adjustment aims to allow for mix in cases arriving at the hospital so tat the hospital is not penalised for the increase in the cost per admission being due to a higher case mix
Primary healthcare
First point of contact between patients and healthcare systems
Involves health promotion, disease prevention , diagnosis , treatment of common illness, and the management of chronic disease
Secondary
Specialised services provided by medial specialists or health care facilities - such as hospitals for more complex medical conditions that require advanced medical intervention
tertiary
Highly specialised medical care provided by specialised hospitals or medical centres for patients with complex medical conditions or who require intensive care
8 primary care benefits
- GP
- Dentistry
- Eye care benefits
- Preventative healthcare services
- Wellness programs
Chronic disease management - Maternal and child healthcare services
- Mental health and behavioural health services
- Pathology
- Basic radiology such as X-rays
- Rehabilitation service - physical therapy and occupational therapy
Benefit design structures that can be used to clearly define benefit entitlement for new primary healthcare insurance
- frequency design ( limits the number of visits per policyholder )
- Monetary amount design - sets a limit on total amount that insurance will pay for primary health care
- Unit design - unit of benefit entitlement - “per life” or “er family”
- co-payments/ cost sharing ( requires policyholders to pay a certain % of cost of a premiary healthcare service )
- Scope of cover - do they include consultations , medications or minor in0room procedures
- MSA
Key factors that you would consider when designing the benefit package
- demographic profile of the target market - age , gender and location to tailor the benefit package to their specific healthcare needs
- prevalence of diseases and health conditions - common in target market
- available of primary healthcare facilities in target market and quality of care
- cost of primary healthcares services and affordability
- degree of competition - price sensitivity
- scope of primary healthcare covered by other competitors
- regulatory requirements and level of compliance
- financial sustainability of the new product
- impact of medical inflation
- the level of innovation and technology
- the feed back and input from healthcare providers and industry experts
- the potential for new product to attract new customers
- the level fo customer staisfaction and engagement
- level of risk and how to mitigate
Indented 4 MCO’s interventions
- Pre-authorisation of hospital admissions
- High-cost case management
- monitor and intervene for high cost cases
- reduce wastages/ unnecessary services
- assist in discharge planning - Preferred provider network
- treatment protocols
- set treatment standards for in-and out-o-hospital treatments
- ensue quality of care and reduce unnecessary care - Medicine formularies
- various classes of drugs , diagnosis and specify specific gdrugs covered - Risk-sharing arrangements - capitation. Fixed fees , …
- Quality measures and reporting
- monitor impact and report on key quality metrics
Analyse utilisation and performance by r providers
