北美精算师考试SOA：真题精要November2003Course8M（6），请早日看完。时间不太多了，然后抓紧时间看其他章节。
　　14. (5 points) You are a consultant hired by TeethFerry.com, a company hoping to use the
　　Internet to market dental plans. They have created a marketing communication to be sent
　　to companies that do not currently have a benefits program.
　　From: TeethFerry.com
　　Subject: Quality Dental Coverage with 3 Months at No Charge
　　Affordable Dental Coverage
　　?  save up to 60% on all your dental needs
　　?  choose from 15 of the finest nationwide and regional plans
　　?  pay premiums, submit claims, get the latest information, all on your desktop!
　　(a) List the general types of delivery systems for dental plans and their major
　　features.
　　(b) Outline plan provisions and claim practices that dental insurers can use to
　　limit cost and anti-selection.
　　(c) Describe challenges that e-commerce companies must overcome to be
　　successful.
　　COURSE 8: Fall 2003 - 11 - GO TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
　　Questions 15 - 18 pertain to the case study
 
　　15. (4 points) The Bedford Group is exploring alternatives to acute inpatient care. A study
　　by Bedford’s Medical Director indicates the MCO might benefit from a program to
　　encourage patients with conditions requiring less intensive treatment to be moved from
　　acute care facilities to a Skilled Nursing Facility (SNF). The initiative would transfer
　　acute care patients to the SNF at Hospital ID1 and is expected to result in the following
　　changes:
　　Reduction in
　　Medical Acute Days
　　Reduction in
　　Surgical Acute Days
　　Hosp ID1 1.0% 0.5%
　　Hosp ID2 2.0% 2.0%
　　Hosp ID3 1.5% 1.0%
　　(a) Assuming the above reductions are realized, and based on Table MC-2, calculate
　　the expected change in medical, surgical and SNF days/1000 and the change in
　　medical/surgical length of stay in 2002 for the MCO. Show your work.
　　(b) Describe behavioral health channeling mechanisms available to direct individuals
　　to the appropriate type of care.
　　COURSE 8: Fall 2003 - 12 - GO TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
　　Questions 15 - 18 pertain to the case study
 
　　16. (4 points) You are a consulting actuary for Hospital ID1. The Bedford Group is
　　proposing to capitate Hospital ID1 for inpatient hospital services incurred by its
　　members. You have been asked by Hospital ID1 to develop capitation targets for
　　negotiations with the Bedford Group.
　　In addition to information provided in Tables MC-2 and MC-7, you have made the
　　following assumptions:
　　?  administrative expenses: 8% of capitation
　　?  risk charges: 6% of capitation
　　?  the 2002 hospital experience is credible
　　(a) Using an actuarial cost model based on your current provider contract with
　　Bedford Group, calculate the base pmpm cost. Show your work.
　　(b) List key assumptions that should be considered when determining the utilization,
　　average cost and pmpm targets in an actuarial cost model.
　　(c) Describe additional considerations that Hospital ID1 should consider when
　　*uating a capitation proposal.
　　COURSE 8: Fall 2003 - 13 - GO TO NEXT PAGE
　　Managed Care Segment
　　高顿网校之心灵鸡汤：人的一生就是这样，先把人生变成一个科学的梦，然后再把梦变成现实。——法国