Optimizing Value-Based Healthcare Pricing Through Actuarial Science: A Theoretical Approach

Author(s)	Felix Okumu, Esther Esi Assan
Country	United States
Abstract	Value-based healthcare (VBHC) seeks to align healthcare spending with outcomes, yet implementation has been constrained by challenges in risk adjustment, cost measurement, and incentive design. This paper explores the integration of actuarial science into VBHC pricing models, drawing on established concepts such as utility theory, cost-effectiveness analysis, and principal–agent theory. Literature on payment reform and actuarial modeling highlights how actuarially informed approaches can strengthen outcome measurement, reduce inefficiencies, and improve equity in care delivery. Challenges remain, including patient heterogeneity, ethical concerns in pricing, and regulatory barriers. Future research should expand the use of predictive analytics, explore actuarial approaches to personalized pricing, and incorporate social determinants of health. A hybrid framework combining actuarial methods, health economics, and data science offers a promising pathway to more sustainable and equitable healthcare financing.
Field	Physical Science
Published In	Volume 17, Issue 1, January-March 2026
Published On	2026-02-26

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International Journal on Science and Technology