The text of this paper, together with the abstract of the discussion held by the Institute of Actuaries on 27 February 1995, are printed in British Actuarial Journal, 1, IV, pages 603-688.

The paper discusses the role of actuaries within the NHS. Actuaries have applied the concept of Geographic Information Systems to health data on patient traffic flows, transportation studies and specialty specific information on NHS providers (such as hospitals, ambulance stations and GP practices). Actuaries have been working with NHS Trusts to generate private patient income. Actuarial modelling developments, as part of a multi-disciplinary approach, have been used to interpret health data and to assist with the reconfiguration of NHS services. Actuaries have also been involved in long-term health services planning and in the financial planning of services for chronically ill patients.

The paper outlines a series of case studies involving actuaries working in the NHS, highlighting their unique contributions. The case studies include advising on emergency health services planning, acute hospital service planning, NHS Trust private patient unit income generation, comparative peer group ranking studies, long-term population projections, health needs assessment and a feasibility study for a provider unit to care for the chronically ill. Finally, we discuss the role of the actuary in the NHS and his or her ability to build a communication bridge between NHS purchasers and providers, in the public interest.

This paper surveys some statistical models of survival data. A basic model of a random lifetime is defined, and censoring is introduced. Methods based on observations of small segments of lifetimes are compared. Markov and semi-Markov (multiple state) models are recommended as well-understood and flexible models well suited to actuarial data. A Poisson model is discussed as an approximation to a two state model, while traditional Binomial-type models are shown to be more restricted and less tractable than multiple state models.

The bias inherent in select mortality investigations where data are grouped by coincident or non-coincident rate intervals is analysed and compared. The key to the bias is shown to be the particular patterns of non-uniform ‘exposure frequency’ inherent in each method. It is shown that the bias using the non-coincident rate intervals is sensitive to a non-uniform distribution of new entrants by age, while the use of coincident rate intervals is sensitive to making appropriate assumptions regarding the distribution of policy anniversaries over life-time, p(s). Under both methods a significant proportion of the bias is retained after graduation. It is shown that non-coincident rate intervals may be preferred where p(s) is unknown, as in the CMI Bureau's investigations, while coincident rate intervals would be preferred where p(s) is known and taken into account in deriving the age for the estimated rates.

The provision of graduated mortality rates, for the United Kingdom pensioners' experience, based on the so-called ‘amounts’ data sets is addressed. Specifically a methodology is investigated, building on the existing methods practiced by the CMI Bureau, which takes a more detailed account of the underlying structure of the data involved. The method is applied to the U.K. pensioners' experience and recent mortality trends in this experience revealed.

This paper considers the variety of social security and complementary pension scheme arrangements which have developed in different countries, and examines some recent trends in pension reforms, designed to address the problem of the ageing population and other structural shortcomings in existing structures.

Consolidation of FT-SE Actuaries share indices, and of revised 1994 Industrial Classification system. New Fledgling Index.

This note continues a regular series on mortality rates in the United Kingdom. Mortality experienced in 1993 is shown by five-year age groups, and comparisons are made for broad age groups, on a standardised basis, with mortality in earlier years.