Actuaries can analyze healthcare trends to determine if rates are reasonable and if reserves are adequate. In this talk, we will provide a framework of methods to analyze the healthcare trend during the pandemic. COVID-19 may influence future healthcare cost trends in many ways. First, direct COVID-19 costs may increase the amount of total experienced healthcare costs. However, with the implementation of social distancing, the amount of regularly scheduled care may be deferred to a future date. There are also many unknown factors regarding the transmission of the virus. Implementing epidemiology models allows us to predict infections by studying the dynamics of the disease. The correlation between infection amounts and hospitalization occupancies provide a methodology to estimate the amount of deferred and recouped amounts of regularly scheduled healthcare costs. Thus, the combination of the models allows to model the healthcare cost trend impact due to COVID-19.

Many would contend that the United States healthcare system should be moving towards a state of health equity. Here, every individual is not disadvantaged from achieving their true health potential. However, a variety of barriers currently exist that restrict individuals across the country from attaining equitable health outcomes; one of these is the social determinants of health (SDOH). The SDOH are non-medical factors that influence the health outcomes of an individual such as air pollution, food insecurity, and transportation accessibility. Each of these factors can influence the critical illnesses and health outcomes of individuals and, in turn, diminish the level of health equity in affected areas. Further, the SDOH have a strong correlation with lower levels of health outcomes such as life expectancy, physical health, and mental health. Despite having influenced the United States health care system for decades, the industry has only begun to address its influences within the past few years. Through exploration between the associations of the SDOH and health outcomes, programming and policy-making can begin to address the barrier to health equity that the SDOH create.

The United States spends far more on healthcare than other developed countries, and it is increasing at a rapid pace that places intense financial pressure on the American public. The high levels of spending are not attributable to increased quality of care or a healthier general population. Rather, the culprits are a combination of uniquely American social and cultural factors that increase the prevalence of chronic illness coupled with a large and complex healthcare industry that has a multitude of stakeholders, each with their own motivations and expense margins that inflate prices. Additionally, rampant lack of transparency, overutilization and low-quality care contribute to unnecessarily frequent and expensive payments. Public and private institutions have implemented legislation and programs that provide temporary relief, but powerful lobbying efforts by healthcare-related organizations and a general American aversion to high government involvement have prevented the United States from creating effective, long-lasting reform.