Session 55 PD, Actuaries and the International Market. Moderator/Presenter: Ian G. Duncan, FSA, FIA, FCIA, MAAA

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1 Session 55 PD, Actuaries and the International Market Moderator/Presenter: Ian G. Duncan, FSA, FIA, FCIA, MAAA Presenters: Jorge A. Alvidrez, ASA, MAAA Jeremiah D. Reuter, ASA, MAAA

2 Actuaries and the International Market Mexico Jorge A. Alvidrez President/CEO InnoQual Health & Actuarial Consulting, LLC

3 Mexico Country Profile 2013 population million (World Bank) 2013 GDP - $1.26 trillion dollars or $10,303 per capita (World Bank) 2013 GDP (PPP) - $16,370 per capita (World Bank) One of the largest and highest-income countries in latin america Healthcare spend is 6-7% of GDP Effectively achieved universal healthcare coverage in 2012 by growing a universal coverage effort, Seguro Popular, launched in 2004

4 Mexico Country Profile cont d Over 90% of the population covered under public programs IMSS ISSSTE Seguro Popular Roughly 7% of the population covered by private health insurance (based on Comision Nacional de Seguros y Fianzas coverage data) Private healthcare operates on the free-market system

5 IMSS (Instituto Mexicano del Seguro Social) Founded in 1943 Covers private sector workers Compulsory, tripartite funding scheme Federal government social quota Employer Employee Progressive employee contributions; higher paid workers pay more All-inclusive coverage at IMSS-owned and operated facilities

6 ISSSTE (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado) Founded in 1959 Covers federal and state government workers Compulsory, tripartite funding scheme Federal government social quota Employer (federal and local governments) Employee Progressive employee contributions; higher paid workers pay more All-inclusive coverage at ISSSTE-owned and operated facilities

7 Seguro Popular Started operations January 2004 Federal governments response to the uninsured Voluntary; covers self-employed, unemployed, informal workforce Tripartite funding scheme Federal government social quota Federal and state government solidarity quota Member income-based sliding scale (ranges $0 to ~$1,000 dollars annually) Scheduled benefits covering specified conditions, services and drugs Separate network consisting of state operated facilities

8 Seguro Popular Growth Millions of People Source: The Mexican Social Protection System in Health, Bonilla-Chacin and Aguilera, 2013.

9 Public and Private Insurance Coverage vs. Free Market System Covered Lives (2012) Funding/Expenditures (2010) 1% 7% 42% 42% IMSS ISSSTE Seguro Popular Other Public Private Insurance 50% 50% Government/Employer Households 8% Source: Various Source: The Mexican Social Protection System in Health, Bonilla-Chacin and Aguilera, 2013

10 Demographic and Epidemiological Transition In the past 20 years Smaller families generally Growth in single member households Aging population Median age 1990 = 19 Median age 2012 = 26 (US = 37, Canada = 40) Increased incidence of chronic disease => more complex treatments Federal government initiatives to improve quality and efficiency of public healthcare system Federal government initiatives to improve funding in underserved areas through Seguro Popular and other programs

11 Private Health Insurance - Steady Premium Growth Covered Lives - Millions $50 $45 $40 $35 $30 $25 $20 $15 $10 $5 $- Retained Premium Billions of Pesos Source: Comision Nacional de Seguros y Fianzas (CNSF)

12 Private Health Insurance Sector Performance $6,000 $5,000 $4,000 $3,000 $2,000 $3,762 Per Capita Cost in Pesos $2,702 $2,539 $2,508 $3,625 $5,236 $4,732 $4,866 $4,569 $4,466 76% 74% 72% 70% 68% 66% 70% 70% 71% Loss Ratio 67% 66% 72% 71% 71% 73% 74% $1,000 64% $0 62% Source: Private insurance figures calculated based on CNSF data

13 Medical Tourism is a Growing Industry About 50% of the almost 1 million Californians that cross the border into Mexico each year for health care are Mexican immigrants (Shawn Rhea, 2009, reporting on a study by UCLA entitled Heading South: Why Mexican Immigrants in California Seek Health Services in Mexico) Savings of 40-70% Biggest draws are weight loss surgeries and dental work followed by cosmetic surgery CIMA is a US-owned hospital chain with facilities throughout latin america, including Mexico, seeking to profit from medical tourism The Mexico-based Angeles hospital chain is attempting to do the same thing within Mexico

14 Developments in the U.K. Ian Duncan FSA FIA FCIA FCA MAAA

35 Health Care in Brazil

36 Brazil Overview $1,083 Total Expenditure on Health Care per Capita, 2013 (USD) 2

37 Brazil Health Coverage Unified Health System (SUS) Created in 1988 Health is a right of every citizen, and a duty of the State Funded by federal, state, and municipal government No cost sharing Private system Approximately 20% of the population seeks coverage through private insurers Public health care is still accessible should you need to use it Several hundred firms offering four principal types of medical plans: private health insurance, prepaid group practice, medical cooperatives, and company health plans 3

38 Brazil Payers 4

39 Brazil Health System Challenges 93 percent of Brazilians say that both public and private health care are okay, bad, or terrible. Of those who use the public health care system, 87 percent expressed dissatisfaction. Of those surveyed, 62 percent said health care overall was bad or terrible. Those who identified health care as such tended to live in larger cities, have more education, and higher salaries. In the last two years, 92 percent of Brazilians used the public health care system, and 89 percent received assistance through this system. Most of those who had to wait to receive care (ranging from weeks to months) were women between 25 and 55 years old and of low income. Around 57 percent said that health should be the federal government's priority, compared to 18 percent for education and 8 percent for fighting corruption. But it's not just the public system. Around 70 percent of those with private health care plans said their care was bad or terrible. Around 47 percent said they would rather pay less taxes and buy private health care, and 43 percent said they'd rather pay high taxes and keep public care. Source: Datafolha poll contracted by the National Council of Medicine 5

40 Brazil Health System Challenges Underfinanced system Universal health care priorities Fragmented national networks Lack of sufficient human resources Lack of active social participation Unequal health care between population groups and regions Inefficiency Overload of urgent and emergency care requests Low production capacity Source: 6

41 Jeremiah Reuter, ASA, MAAA Director, Provider Risk Advisory Consulting Optum M T Jeremiah.Reuter@Optum.com Jeremiah is a Director in the Provider Risk Advisory team within the Network and Population Health Consulting division in Optum. He is in his 15 th year working in the health care actuarial field. His primary focus has been in the area of U.S. healthcare consulting. He has worked with health insurance plans, health care providers, ACOs, Medicare Advantage plans, CMS and state and national regulatory agencies. Jeremiah also has an extensive background in international healthcare, having spent two years working with the National Health Service (NHS) in the UK as well as working with Canadian principals. Jeremiah currently serves in the chief actuary role for ACOs as well as leading the valuation team for a top-10 health insurer. Jeremiah is also currently consulting with health plans and health care providers on the impact of the Affordable Care Act (ACA) legislation on providers. He is a member of the American Academy of Actuaries and an Associate of the Society of Actuaries. Jeremiah graduated magna cum laude from Mayville State University with a double major in mathematics and physical science. He also holds a Master of Science degree in mathematics from the University of North Dakota. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.

Session 110 PD, ACOs and Value Based Care. Moderator: James Patrick Hazelrigs, ASA, MAAA

Session 110 PD, ACOs and Value Based Care Moderator: James Patrick Hazelrigs, ASA, MAAA Presenters: Johann K. Leida, FSA, MAAA Chris Pallot Jeremiah D. Reuter, ASA, MAAA Chris Pallot Director of Strategy