are moving toward greater public support. Thus, the financial analyses of end-of-life care will become more complex
■ Actuaries can help demonstrate to the health plans that an
appropriate end-of-life benefit coverage and provider/patient
education not only enhance the quality of patient care, but
also make financial sense for the plan.
■ The infrastructure of the health care system may have to
change as the care shifts from acute care to palliative care.
These shifting responsibilities may require the education of
health care actuaries to change.
The issues surrounding end-of-life care for the elderly will
become more severe due to the aging population and shifting
demographics. Nearly all countries in the first and second world
will be affected. However, very few have begun the long-term
As the pace of the population aging accelerates, and a greater
portion of some countries’ gross domestic product is consumed
by health care and other social programs for the elderly, the so-
lutions will become increasingly difficult to implement, and will
place significant economic burden on this generation and the
next. Solutions for the increasing burdens of heath care costs
will need to include changes in public policy, culture, and at-
titudes, in addition to changes within the health care industry
Solutions for the care of the elderly at the end of life are
multifaceted and should consider public policy, financial cons-
traints, regional differences, cultural and religious norms, and
individual and family positions. They must also be created by all
players—policymakers, providers, families, and the elderly. Poli-
cymakers can redirect national, regional, and local resources as
well as set policies to assist in aligning the incentives. Provider
solutions can include realistically assessing the clinical effec-
tiveness of end-of-life care, the additional training for palliative
care, and contracts that align incentives for end-of-life care. In-
dividuals and families can also be realistic about the outcome
of the care they discuss with their providers, learn more about
the progression of chronic diseases they may suffer from, and
put into place advanced directives and care plans.
None of these solutions will be easy—but holistic considerations of the elements of end-of-life care are necessary to effectively
address the shifting needs of the elderly population.
YAIR BABAD is a professor emeritus at the University of Illinois,
Chicago, and a fellow of the Israeli Actuarial Association. APRIL S. CHOI
is a member of the Academy, a fellow of the Society of Actuaries, and
chairperson of the International Actuarial Association Health Section.
She is the principal and consulting actuary for KAC Group LLC. RIAN
DE JONGE is a fellow of the Royal Dutch Actuarial Association and a
senior manager and the health lead at PwC in the Netherlands. JASON
GOELLNI TZ is a statistics student at the University of California, Santa
Barbara and an intern at Graphiq Inc. ALEX T. LEUNG, a member of the
Academy and a fellow of the Society of Actuaries, is the head of health
& wellness strategy at ConneXionsAsia. SUSAN MA TEJA is a member
of the Academy and a fellow of the Society of Actuaries, and chairperson
of the Academy’s Health Practice International Committee. She is an
actuarial director with Humana. DANIEL PRIBE, a member of the
Academy and a fellow of the Society of Actuaries, is the vice president
of revenue strategy and principal actuary with Lumeris. ZERONG YU, a
member of the Academy and a fellow of the Society of Actuaries, is the
director of actuarial services with Memorial Hermann Health System.
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