GH 101: Benefit design affects utilisation as well as reimbursement

Changing a deductible or copayment changes the insurer’s payment function. Behaviour and selection can also change, but those effects require separate evidence and assumptions.

Original practice scenario

For an original benefit with a 100 deductible, calculate payments on claims of 80 and 500. Raise the deductible to 200 and repeat. Explain why the observed reduction on these fixed claims alone does not estimate a whole plan’s prospective cost, especially if utilisation changes.

Study check

Write the assumptions, the decision being supported and one limitation. Use the current course syllabus for the required terminology and scope; this introductory guide is not a complete course summary.

Reading sources

• Official syllabus and resources

ActNet editorial guide · October 1, 2026 · Original illustrative examples.