Regulating Genetic Information in Insurance Markets

Genetic risk scores in life insurance underwriting

Genetic tests that predict the lifetime risk of common medical conditions are fast becoming more accurate and affordable. The life insurance industry is interested in using predictive genetic tests in the underwriting process, but more research is needed to establish whether this nascent form of genetic testing can refine the process over conventional underwriting factors. Here, we perform Cox regression of survival on a battery of genetic risk scores for common medical conditions and mortality risks in the Health and Retirement Study, without returning results to participants. Adjusted for covariates in a relevant insurance scenario, the scores could improve mortality risk classification by identifying 2.6 years shorter median lifespan in the highest decile of total genetic liability. We conclude that existing genetic risk scores can already improve life insurance underwriting, which stresses the urgency of policymakers to balance competing interests between stakeholders as this technology develops.

Guiding Pay-As-You-Live Health Insurance Models Toward Responsible Innovation in Health

While the transition toward digitalized health care and service delivery challenges many publicly and privately funded health systems, patients are already producing a phenomenal amount of data on their health and lifestyle through their personal use of mobile technologies. To extract value from such user-generated data, a new insurance model is emerging called Pay-As-You-Live (PAYL). This model differs from other insurance models by offering to support clients in the management of their health in a more interactive yet directive manner. Despite significant promises for clients, there are critical issues that remain unaddressed, especially as PAYL models can significantly disrupt current collective insurance models and question the social contract in so-called universal and public health systems. In this paper, we discuss the following issues of concern: the quantification of health-related behavior, the burden of proof of compliance, client data privacy, and the potential threat to health insurance models based on risk mutualization. We explore how more responsible health insurance models in the digital health era could be developed, particularly by drawing from the Responsible Innovation in Health framework.

Managing genetic tests, surveillance, and preventive medicine under a public health insurance system

There is a prospect in the medium to long term future of substantial advancements in the understanding of the relationship between disease and genetics. We consider the implications of increased information from genetic tests about predisposition to diseases from the perspective of managing health care provision under a public health insurance scheme. In particular, we consider how such information may potentially improve the targeting of medical surveillance (or prevention) activities to improve the chances of early detection of disease onset. We show that the moral hazard implications inherent in surveillance and prevention decisions that are chosen to be privately rather than socially optimal may be exacerbated by increased information about person-specific predisposition to disease.

The Impact of Genetic Testing and Genetic Information on Ethical, Legal and Social Issues in North America

This chapter discusses the impact of genetic testing and genetic information. It proposes a framework that facilitates a critical analysis of the ethical, legal, and social issues of genetic testing. The ethical effects include privacy infringement, genetic discrimination, misleading advertisement, psychological impact, and individual autonomy. The legal impacts embrace consistent terminology, referral guidelines, patent wars, and new legislations. The social effects pertain to inequality, higher insurance fees, tax burden, and fear of new eugenics. Information and communication technologies dramatically augment the effect of genetic testing on these outcomes. This chapter argues that information and communication technologies and rapid advances in genetics challenge the existing legislation systems in North America. Therefore, policy-makers need to address the tension between the potential benefits and harms of genetic testing and genetic information.