The modern actuary in healthcare – how can we help public healthcare systems under strain?

The modern actuary in healthcare – how can we help public healthcare systems under strain?

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When we think ‘modern actuary’, our minds jump to ‘Big Data, ‘Machine Learning, ‘AI’ and a futuristic world where technology reigns supreme. While the world may be moving in this direction, healthcare systems around the globe continue to operate under massive strain. A key question we should be asking is “What can actuaries do about it and how can we contribute to related social and economic development goals?”

In this session, we explore the role of the modern actuary in healthcare by going back to basics and unpacking how our skills and expertise can be applied in the public sector where there is appetite to re-design healthcare systems to improve access to healthcare while lowering financial pressures and maintaining/improving quality. We also address the idiosyncrasies of healthcare and how its unique features call for a multi-disciplinary approach and a wide range of skill sets to address the challenges that these systems face (e.g. clinicians, health economists, financial experts as well as strategic and operational expertise).

We will bring this topic to life by discussing different types of healthcare systems around the world and how they operate and evolve over time. Through case studies from the UK, Middle East, Pakistan and Ghana, we will contrast how these different healthcare systems operate and showcase our role as actuaries in this space. We will discuss how we have conducted system-level actuarial analyses to understand the current and projected healthcare cost and utilisation profile of the system as well as how this experience may differ if it conformed to ‘well-managed’ international best practice benchmark levels.

Taking this analysis further, we will also consider how this may be used when thinking about new models of care and introducing risk-share/gain-share mechanisms in the environment. Our session will also draw attention to the softer elements that are required to make these efforts a success and the importance of understanding the bigger picture while keeping the perspective of all stakeholders in mind to ensure that the substantial efforts we employ are relevant, understood and implementable.

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