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Muller C, Gallacher L, Keogh L, McInerney-Leo A, Boughtwood T, Gleeson P, Barlow-Stewart K, Delatycki MB, Winship I, Nowak KJ, Otlowski M, Lacaze P, Tiller J. "Uninsurable because of a genetic test": a qualitative study of consumer views about the use of genetic test results in Australian life insurance. Eur J Hum Genet 2024; 32:827-836. [PMID: 38637700 PMCID: PMC11219861 DOI: 10.1038/s41431-024-01602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/22/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
Genetic testing can provide valuable information to mitigate personal disease risk, but the use of genetic results in life insurance underwriting is known to deter many consumers from pursuing genetic testing. In 2019, following Australian Federal Parliamentary Inquiry recommendations, the Financial Services Council (FSC) introduced an industry-led partial moratorium, prohibiting life insurance companies from using genetic test results for policies up to $AUD500,000. We used semi-structured interviews to explore genetic test consumers' experiences and views about the FSC moratorium and the use of genetic results by life insurers. Individuals who participated in an online survey and agreed to be re-contacted to discuss the issue further were invited. Interviews were 20-30-min long, conducted via video conference, transcribed verbatim and analysed using inductive content analysis. Twenty-seven participants were interviewed. Despite the moratorium, concerns about genetic discrimination in life insurance were prevalent. Participants reported instances where life insurers did not consider risk mitigation when assessing risk for policies based on genetic results, contrary to legal requirements. Most participants felt that the moratorium provided inadequate protection against discrimination, and that government legislation regulating life insurers' use of genetic results is necessary. Many participants perceived the financial limits to be inadequate, given the cost-of-living in Australia. Our findings indicate that from the perspective of participants, the moratorium has not been effective in allaying fears about genetic discrimination or ensuring adequate access to life insurance products. Concern about genetic discrimination in life insurance remains prevalent in Australia.
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Affiliation(s)
| | - Lyndon Gallacher
- University of Melbourne, Parkville, VIC, Australia
- Victorian Clinical Genetics Services, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Aideen McInerney-Leo
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, QLD, Australia
| | - Tiffany Boughtwood
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Australian Genomics, Melbourne, VIC, Australia
| | | | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, VIC, Australia
| | - Martin B Delatycki
- Victorian Clinical Genetics Services, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Ingrid Winship
- Department of Medicine, the University of Melbourne, Melbourne, VIC, Australia
- Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kristen J Nowak
- Office of Population Health Genomics, Western Australia Department of Health, Perth, WA, Australia
| | - Margaret Otlowski
- Faculty of Law and Centre for Law and Genetics, University of Tasmania, Hobart, TAS, Australia
| | - Paul Lacaze
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jane Tiller
- Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Australian Genomics, Melbourne, VIC, Australia.
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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Yanes T, Blencoe M, Howard A, Tiller J, Wallingford C, Otlowski M, Keogh L, Lacaze P, McInerney-Leo A. Australian researcher's perspectives on the Australian industry-led moratorium on genetic tests in life insurance. Am J Med Genet A 2024; 194:e63565. [PMID: 38353314 DOI: 10.1002/ajmg.a.63565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 05/02/2024]
Abstract
Fear of insurance discrimination can inhibit genetic research participation. In 2019, an industry-led partial moratorium on using genetic results in Australian life insurance underwriting was introduced. This mixed-methods study used online surveys (n = 59 participants) and semi-structured interviews (n = 22 participants) to capture researchers' perceptions about the moratorium. 66% (n = 39/59) were aware of the moratorium before the survey. Of researchers returning genetic results, 56% (n = 22/39) reported that insurance implications were mentioned in consent forms, but a minority reported updating consent forms post-moratorium (n = 13/39, 33%). Most researchers reported that concerns regarding life insurers utilizing research results inhibited recruitment (35/59, 59%), and few perceived that the moratorium positively influenced participation (n = 9/39, 23%). These findings were supported by qualitative findings which revealed that genetic discrimination concerns were a major issue for some individuals, though these concerns could be eclipsed by the promise of a diagnosis through research participation. The majority thought a regulatory solution should be permanent (n = 34/51, 67%), have financial limits of at least ≥1,000,000 AUD (37/51, 73%), and involve government oversight/legislation (n = 44/51, 86%). In an era where an increasing number of research studies involve genomics as a primary or secondary objective, it is crucial that we have regulatory solutions to address participants' hesitation.
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Affiliation(s)
- Tatiane Yanes
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Marisa Blencoe
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Antonia Howard
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jane Tiller
- School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Courtney Wallingford
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | | | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Lacaze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Aideen McInerney-Leo
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
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Tiller J, Bakshi A, Dowling G, Keogh L, McInerney-Leo A, Barlow-Stewart K, Boughtwood T, Gleeson P, Delatycki MB, Winship I, Otlowski M, Lacaze P. Community concerns about genetic discrimination in life insurance persist in Australia: A survey of consumers offered genetic testing. Eur J Hum Genet 2024; 32:286-294. [PMID: 37169978 PMCID: PMC10923945 DOI: 10.1038/s41431-023-01373-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/16/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
Fears of genetic discrimination in life insurance continue to deter some Australians from genetic testing. In July 2019, the life insurance industry introduced a partial, self-regulated moratorium restricting the use of genetic results in underwriting, applicable to policies up to certain limits (eg AUD$500,000 for death cover).We administered an online survey to consumers who had taken, or been offered, clinical genetic testing for adult-onset conditions, to gather views and experiences about the moratorium and the use of genetic results in life insurance, including its regulation.Most respondents (n = 367) had undertaken a genetic test (89%), and had a positive test result (76%; n = 243/321). Almost 30% (n = 94/326) reported testing after 1 July 2019. Relatively few respondents reported knowing about the moratorium (16%; n = 54/340) or that use of genetic results in life insurance underwriting is legal (17%; n = 60/348). Only 4% (n = 14/350) consider this practice should be allowed. Some respondents reported ongoing difficulties accessing life insurance products, even after the moratorium. Further, discrimination concerns continue to affect some consumers' decision-making about having clinical testing and applying for life insurance products, despite the Moratorium being in place. Most respondents (88%; n = 298/340) support the introduction of legislation by the Australian government to regulate this issue.Despite the introduction of a partial moratorium in Australia, fears of genetic discrimination persist, and continue to deter people from genetic testing. Consumers overwhelmingly consider life insurers should not be allowed to use genetic results in underwriting, and that federal legislation is required to regulate this area.
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Affiliation(s)
- Jane Tiller
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
- Murdoch Children's Research Institute, Parkville, Australia.
- Australian Genomics, Melbourne, Australia.
| | - Andrew Bakshi
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Grace Dowling
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Aideen McInerney-Leo
- The University of Queensland Diamantina Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Tiffany Boughtwood
- Murdoch Children's Research Institute, Parkville, Australia
- Australian Genomics, Melbourne, Australia
| | | | - Martin B Delatycki
- Murdoch Children's Research Institute, Parkville, Australia
- Victorian Clinical Genetics Services, Parkville, Australia
| | - Ingrid Winship
- Department of Medicine, the University of Melbourne, Melbourne, Australia
- Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, Australia
| | - Margaret Otlowski
- Faculty of Law and Centre for Law and Genetics, University of Tasmania, Hobart, Australia
| | - Paul Lacaze
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Tiller JM, Stott A, Finlay K, Boughtwood T, Madelli EO, Horton A, Winship I, Nowak K, Otlowski M. Direct notification by health professionals of relatives at-risk of genetic conditions (with patient consent): views of the Australian public. Eur J Hum Genet 2024; 32:98-108. [PMID: 37280361 PMCID: PMC10242214 DOI: 10.1038/s41431-023-01395-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/27/2023] [Accepted: 05/16/2023] [Indexed: 06/08/2023] Open
Abstract
Genetic risk information for medically actionable conditions has relevance for patients' blood relatives. However, cascade testing uptake in at-risk families is <50%, and the burden of contacting relatives is a significant barrier to dissemination of risk information. Health professionals (HPs) could notify at-risk relatives directly, with patients' consent. This practice is supported by international literature, including strong public support. However, there is little exploration of the Australian public's views about this issue. We surveyed Australian adults using a consumer research company. Respondents were provided a hypothetical scenario and asked about views and preferences regarding direct contact by HPs. 1030 members of the public responded, with median age 45 y and 51% female. The majority would want to be told about genetic risk for conditions that can be prevented/treated early (85%) and contacted directly by a HP (68%). Most preferred a letter that included specific information about the genetic condition in the family (67%) and had no privacy concerns about HPs sending a letter using contact details provided by a relative (85%). A minority (< 5%) had significant privacy concerns, mostly about use of personal contact information. Concerns included ensuring information was not shared with third parties. Almost 50% would prefer that a family member contacted them before the letter was sent, while about half did not prefer this or were unsure. The Australian public supports (and prefers) direct notification of relatives at risk of medically actionable genetic conditions. Guidelines would assist with clarifying clinicians' discretion in this area.
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Affiliation(s)
- Jane M Tiller
- Australian Genomics, Parkville, VIC, Australia.
- Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Ami Stott
- Australian Genomics, Parkville, VIC, Australia
| | - Keri Finlay
- Australian Genomics, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Tiffany Boughtwood
- Australian Genomics, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Evanthia O Madelli
- Australian Genomics, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Ari Horton
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
- Department of Genomic Medicine, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Ingrid Winship
- Department of Genomic Medicine, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kristen Nowak
- Office of Population Health Genomics, WA Department of Health, East Perth, WA, Australia
| | - Margaret Otlowski
- Centre for Law and Genetics, University of Tasmania, Hobart, TAS, Australia
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Tiller JM, Bakshi A, Brotchie AR, Green RC, Winship IM, Lacaze P. Public willingness to participate in population DNA screening in Australia. J Med Genet 2022:jmg-2022-108921. [DOI: 10.1136/jmg-2022-108921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/01/2022] [Indexed: 12/02/2022]
Abstract
BackgroundPopulation-based DNA screening for medically actionable conditions has the potential to improve public health by enabling early detection, treatment and/or prevention; however, public attitudes and willingness to participate in DNA screening have not been well investigated.MethodsWe presented a scenario to members of the Australian public, randomly selected from the electoral roll via the Australian Survey of Societal Attitudes, describing an adult population DNA screening programme currently under development, to detect risk of medically actionable cancers and heart disease. We asked questions regarding willingness to participate and pay, preferred delivery methods and concerns.ResultsWe received 1060 completed questionnaires (response rate 23%, mean age 58 years). The vast majority (>92%) expressed willingness to undertake DNA screening. When asked about the optimal age of screening, most (56%) favoured early adulthood (aged 18–40 years) rather than at birth or childhood. Many respondents would prefer samples and data be kept for re-screening (36%) or research use (43%); some preferred samples to be destroyed (21%). Issues that decrease likelihood of participation included privacy (75%) and insurance (86%) implications.ConclusionOur study demonstrates public willingness to participate in population DNA screening in Australia, and identifies barriers to participation, to be addressed in the design of screening programmes. Results are informing the development of a pilot national DNA screening programme.
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6
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Dowling G, Tiller J, McInerney-Leo A, Belcher A, Haining C, Barlow-Stewart K, Boughtwood T, Gleeson P, Delatycki MB, Winship I, Otlowski M, Jacobs C, Keogh L, Lacaze P. Health professionals' views and experiences of the Australian moratorium on genetic testing and life insurance: A qualitative study. Eur J Hum Genet 2022; 30:1262-1268. [PMID: 35902697 PMCID: PMC9626480 DOI: 10.1038/s41431-022-01150-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 02/04/2023] Open
Abstract
Australian life insurance companies can legally use genetic test results in underwriting, which can lead to genetic discrimination. In 2019, the Financial Services Council (Australian life insurance industry governing body) introduced a partial moratorium restricting the use of genetic testing in underwriting policies ≤ $500,000 (active 2019-2024). Health professionals (HPs), especially clinical geneticists and genetic counsellors, often discuss the implications of genetic testing with patients, and provide critical insights into the effectiveness of the moratorium. Using a sequential explanatory mixed methods design, we interviewed 23 Australian HPs, who regularly discuss genetic testing with patients and had previously completed an online survey about genetic testing and life insurance. Interviews explored views and experiences about the moratorium, and regulation, in greater depth. Interview transcripts were analysed using thematic analysis. Two key themes emerged from views expressed by HPs during interviews (about matters reported to or observed by them): 1) benefits of the moratorium, and 2) concerns about the moratorium. While HPs reported that the moratorium reassures some consumers, concerns include industry self-regulation, uncertainty created by the temporary time period, and the inadequacy of the moratorium's financial limits for patients' financial needs. Although a minority of HPs felt the current industry self-regulated moratorium is an adequate solution to genetic discrimination, the vast majority (19/23) expressed concern with industry self-regulation and most felt government regulation is required to adequately protect consumers. HPs in Australia are concerned about the adequacy of the FSC moratorium with regards to consumer protections, and suggest government regulation is required.
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Affiliation(s)
- Grace Dowling
- grid.1002.30000 0004 1936 7857Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jane Tiller
- grid.1002.30000 0004 1936 7857Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia ,grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Parkville, Australia
| | - Aideen McInerney-Leo
- grid.1003.20000 0000 9320 7537The University of Queensland Diamantina Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - Andrea Belcher
- grid.1003.20000 0000 9320 7537Faculty of Medicine, University of Queensland, Brisbane, Australia ,Australian Genomics, Melbourne, Australia
| | - Casey Haining
- grid.1008.90000 0001 2179 088XCentre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Kristine Barlow-Stewart
- grid.1013.30000 0004 1936 834XSydney Medical School, University of Sydney, Sydney, Australia
| | - Tiffany Boughtwood
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Parkville, Australia ,Australian Genomics, Melbourne, Australia
| | | | - Martin B. Delatycki
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Parkville, Australia ,grid.507857.8Victorian Clinical Genetics Services, Parkville, Australia
| | - Ingrid Winship
- grid.1008.90000 0001 2179 088XDepartment of Medicine, The University of Melbourne, Melbourne, Australia ,grid.416153.40000 0004 0624 1200Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, Australia
| | - Margaret Otlowski
- grid.1009.80000 0004 1936 826XFaculty of Law and Centre for Law and Genetics, University of Tasmania, Hobart, Australia
| | - Chris Jacobs
- grid.117476.20000 0004 1936 7611Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Louise Keogh
- grid.1008.90000 0001 2179 088XCentre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Paul Lacaze
- grid.1002.30000 0004 1936 7857Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Venning B, Saya S, De Abreu Lourenco R, Street DJ, Emery JD. Preferences for a polygenic test to estimate cancer risk in a general Australian population. Genet Med 2022; 24:2144-2154. [PMID: 35947108 DOI: 10.1016/j.gim.2022.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE There is significant interest in the use of polygenic risk score (PRS) tests to improve cancer risk assessment and stratified prevention. Our current understanding of preferences regarding different aspects of this novel testing approach is limited. This study examined which attributes of a PRS test most influence the likelihood of testing. METHODS A discrete choice experiment was developed to elicit preferences for different aspects of a PRS test by surveying an online sample of the Australian population. Preferences were assessed using mixed logistic regression, latent class analysis, and marginal willingness to pay. RESULTS The 1002 surveyed respondents were more likely to choose a PRS test that was more accurate, tested for multiple cancer types, and enabled cancer risk reduction through lifestyle modification, screening, or medication. There was also a preference for testing through a primary care physician rather than online or through a genetic specialist. A test that did not impact life insurance eligibility or premiums was preferred over the one that did. CONCLUSION This study found that the Australian population prefer a PRS test that is highly accurate, tests for multiple cancers, has noninvasive risk reduction measures, and is performed through primary care.
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Affiliation(s)
- Brent Venning
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia; Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.
| | - Sibel Saya
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia; Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, New South Wales, Australia
| | - Deborah J Street
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, New South Wales, Australia
| | - Jon D Emery
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia; Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
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Lacaze PA, Tiller J, Winship I, Lacaze P, Tiller J, Winship I, Brotchie A, McNeil J, Zalcberg J, Thomas D, Milne R, James P, Delatycki M, Young M, Nowak K, Nguyen‐Dumont T, Southey M, Ademi Z, Bruinsma F, Riaz M, Terrill B, Kirk J, Tucker K, Andrews L, Pachter N, Susman R, Poplawski N, Wallis M, Watts G, Nicholls S, Macrae F, Sturm A, Green R, Ahern S, Revote J, Von Saldern S, Powell S, Rice T. Population DNA screening for medically actionable disease risk in adults. Med J Aust 2022; 216:278-280. [PMID: 35267197 PMCID: PMC9314023 DOI: 10.5694/mja2.51454] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 12/31/2022]
Affiliation(s)
| | | | - Ingrid Winship
- Royal Melbourne Hospital Melbourne VIC
- University of Melbourne Melbourne VIC
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Identification of Potential Valid Clients for a Sustainable Insurance Policy Using an Advanced Mixed Classification Model. SUSTAINABILITY 2022. [DOI: 10.3390/su14073964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Due to the social awareness of risk control, we are witnessing the popularization of the insurance concept and the rapid development of financial insurance. The performance of the insurance industry is highly competitive; thus, in order to develop new and old business from existing clients, information on the renewal of client premiums, purchase of new policies, and new client referrals has become an important research topic in this field. However, based on a review of published literature, few scholars have engaged in relevant research on the above topics by data mining, which motivated the formation of this study, hoping to bridge this gap. We constructed 10 mixed classification prediction models (called Models A–J) using advanced data mining techniques. Moreover, 19 conditional attributes (coded as X1–X19) were selected from the collected insurance client database, plus three different decision attributes (coded as X20–X22): whether to pay the renewal insurance premium, whether to buy a new insurance policy, and whether to introduce new clients. In terms of technical methods, we used two data pretreatment techniques, attribute selection and data discretization, combined with different methods of disassembly in proportion and data cross-validation to conduct data analysis of the collected experimental data set. We also combined and calculated 23 important classification algorithms (or classifiers) in seven different classifications of data mining techniques (i.e., decision tree, Bayes, Function, Lazy, Meta, Mise, and Rule). In terms of the experimental results of insurance data, this study has the following important contributions and findings: (1) finding the best classifier; (2) finding the optimal mixed classification model; (3) determining the best disassembly in proportion; (4) comparing the performance of different disassembly in proportion and data cross-validation methods; (5) determining the important factors influencing the decision attribute “whether to purchase a new insurance policy”, including the time interval to the first purchase, the number of valid policies, the total number of purchased policies, the family salary structure, and gender; and (6) building a knowledge base of decision rules and criteria with the decision tree C4.5 technology, which shall be provided to relevant stakeholders such as insurance dealers and insurance salespeople as a reference for looking for valid clients in the future, and is conducive to the rapid expansion of insurance business. Finally, the important research findings and management implications of this study can serve as a basis for further study of sustainable insurance by academic researchers.
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Prince AE, Uhlmann WR, Suter SM, Scherer AM. Genetic testing and insurance implications: Surveying the US general population about discrimination concerns and knowledge of the Genetic Information Nondiscrimination Act (GINA). RISK MANAGEMENT AND INSURANCE REVIEW 2021; 24:341-365. [PMID: 35663290 PMCID: PMC9165621 DOI: 10.1111/rmir.12195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/05/2021] [Indexed: 06/15/2023]
Abstract
Globally, due to public concerns of genetic discrimination, some countries and insurance industries have adopted policies restricting insurer use of genetic information, such as the US Genetic Information Nondiscrimination Act (GINA). This study reports on combined analysis of two surveys assessing public knowledge of GINA and concerns of genetic discrimination in a diverse U.S. sample (N=1616). We focus on whether occupation, genetic testing history, and insurance status are correlated with knowledge of GINA or concerns of discrimination. While bivariate analysis identified some populations with higher subjective/objective knowledge and concern relative to counterparts, multivariable regression identified very few significant associations with outcomes of interest. Overall, this study highlights lack of awareness and understanding of GINA, even among subpopulations hypothesized to have greater knowledge of the law. These findings have implications for the broader debate around insurer use of genetic information.
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Affiliation(s)
| | - Wendy R. Uhlmann
- Department of Internal Medicine, Division of Genetic Medicine; Department of Human Genetics; Center for Bioethics and Social Sciences in Medicine, University of Michigan School of Medicine
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11
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Marquina C, Lacaze P, Tiller J, Riaz M, Sturm AC, Nelson MR, Ference BA, Pang J, Watts GF, Nicholls SJ, Zoungas S, Liew D, McNeil J, Ademi Z. Population genomic screening of young adults for familial hypercholesterolaemia: a cost-effectiveness analysis. Eur Heart J 2021; 43:3243-3254. [PMID: 34788414 DOI: 10.1093/eurheartj/ehab770] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/29/2021] [Accepted: 10/22/2021] [Indexed: 12/18/2022] Open
Abstract
AIMS The aim of this study was to assess the impact and cost-effectiveness of offering population genomic screening to all young adults in Australia to detect heterozygous familial hypercholesterolaemia (FH). METHODS AND RESULTS We designed a decision analytic Markov model to compare the current standard of care for heterozygous FH diagnosis in Australia (opportunistic cholesterol screening and genetic cascade testing) with the alternate strategy of population genomic screening of adults aged 18-40 years to detect pathogenic variants in the LDLR/APOB/PCSK9 genes. We used a validated cost-adaptation method to adapt findings to eight high-income countries. The model captured coronary heart disease (CHD) morbidity/mortality over a lifetime horizon, from healthcare and societal perspectives. Risk of CHD, treatment effects, prevalence, and healthcare costs were estimated from published studies. Outcomes included quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratio (ICER), discounted 5% annually. Sensitivity analyses were undertaken to explore the impact of key input parameters on the robustness of the model. Over the lifetime of the population (4 167 768 men; 4 129 961 women), the model estimated a gain of 33 488years of life lived and 51 790 QALYs due to CHD prevention. Population genomic screening for FH would be cost-effective from a healthcare perspective if the per-test cost was ≤AU$250, yielding an ICER of <AU$28 000 per QALY gained. From a societal perspective, population genomic screening would be cost-saving. ICERs from societal perspective remained cost-saving after adaptation to other countries. CONCLUSION Based on our model, offering population genomic screening to all young adults for FH could be cost-effective, at testing costs that are feasible.
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Affiliation(s)
- Clara Marquina
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Paul Lacaze
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Jane Tiller
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Moeen Riaz
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Amy C Sturm
- Genomic Medicine Institute, 100 North Academy Avenue, Geisinger, PA 17822, USA
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.,Menzies Institute for Medical Research, 17 Liverpool St, Hobart, TAS 7000, Australia
| | - Brian A Ference
- University of Cambridge, Centre for Naturally Randomised Trials, The Old Schools, Trinity Ln, Cambridge CB2 1TN, UK
| | - Jing Pang
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, 35 Stirling Hwy, Perth, WA 6009, Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, 35 Stirling Hwy, Perth, WA 6009, Australia.,Lipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Victoria Square, Perth, WA 6000, Australia.,Lipid Disorders Clinic, Cardiometabolic Service, Department of Internal Medicine, Royal Perth Hospital, Victoria Square, Perth, WA 6000, Australia
| | - Stephen J Nicholls
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
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12
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Allen KA, McInerney-Leo AM, Gamble N, Wurf G, Boyle C. The ethical protection of genetic information: procedure analysis for psychologists. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1985376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kelly-Ann Allen
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Melbourne, Australia
- The Centre for Wellbeing Science, The Melbourne Graduate School of Education, The University of Melbourne, Parkville, Australia
| | - Aideen M McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Australia
| | - Nicholas Gamble
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Melbourne, Australia
| | - Gerald Wurf
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Melbourne, Australia
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13
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Tiller JM, Keogh LA, McInerney-Leo AM, Belcher A, Barlow-Stewart K, Boughtwood T, Gleeson P, Dowling G, Prince A, Bombard Y, Joly Y, Delatycki M, Winship IM, Otlowski M, Lacaze P. A step forward, but still inadequate: Australian health professionals' views on the genetics and life insurance moratorium. J Med Genet 2021; 59:817-826. [PMID: 34544841 DOI: 10.1136/jmedgenet-2021-107989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/04/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND In 2019, the Australian life insurance industry introduced a partial moratorium (ban) limiting the use of genetic test results in life insurance underwriting. The moratorium is industry self-regulated and applies only to policies below certain financial limits (eg, $500 000 of death cover). METHODS We surveyed Australian health professionals (HPs) who discuss genetic testing with patients, to assess knowledge of the moratorium; reported patient experiences since its commencement; and HP views regarding regulation of genetic discrimination (GD) in Australia. RESULTS Between April and June 2020, 166 eligible HPs responded to the online survey. Of these, 86% were aware of the moratorium, but <50% had attended related training/information sessions. Only 16% answered all knowledge questions correctly, yet 69% believed they had sufficient knowledge to advise patients. Genetics HPs' awareness and knowledge were better than non-genetics HPs' (p<0.05). There was some reported decrease in patients delaying/declining testing after the moratorium's introduction, however, 42% of HPs disagreed that patients were more willing to have testing post-moratorium. Although many (76%) felt the moratorium resolved some GD concerns, most (88%) still have concerns, primarily around self-regulation, financial limits and the moratorium's temporary nature. Almost half (49%) of HPs reported being dissatisfied with the moratorium as a solution to GD. The majority (95%) felt government oversight is required, and 93% felt specific Australian legislation regarding GD is required. CONCLUSION While the current Australian moratorium is considered a step forward, most HPs believe it falls short of an adequate long-term regulatory solution to GD in life insurance.
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Affiliation(s)
- Jane M Tiller
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia .,Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Aideen M McInerney-Leo
- Human Genomics Group, University of Queensland Diamantina Institute, Woolloongabba, Queensland, Australia
| | - Andrea Belcher
- The University of Queensland, Faculty of Medicine, Herston, Queensland, Australia.,Australian Genomics, Melbourne, Victoria, Australia
| | | | - Tiffany Boughtwood
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Australian Genomics, Melbourne, Victoria, Australia
| | - Penny Gleeson
- School of Law, Deakin University, Burwood, Victoria, Australia
| | - Grace Dowling
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Anya Prince
- The University of Iowa College of Law, Iowa City, Iowa, USA
| | - Yvonne Bombard
- University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Yann Joly
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
| | - Martin Delatycki
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services Ltd, Parkville, Victoria, Australia
| | - Ingrid M Winship
- Clinical Genetics, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Paul Lacaze
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
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14
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The Genetic Discrimination Observatory: confronting novel issues in genetic discrimination. Trends Genet 2021; 37:951-954. [PMID: 34503867 DOI: 10.1016/j.tig.2021.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/03/2021] [Indexed: 11/21/2022]
Abstract
Genetic discrimination (GD) is the differential or unfair profiling of an individual on the basis of genetic data. This article summarizes the actions of the Genetic Discrimination Observatory (GDO) in addressing GD and recent developments in GD since late 2020. It shows how GD can take many forms in today's rapidly evolving society.
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15
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Tiller J, Delatycki MB. Genetic discrimination in life insurance: a human rights issue. JOURNAL OF MEDICAL ETHICS 2021; 47:medethics-2021-107645. [PMID: 34131003 DOI: 10.1136/medethics-2021-107645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Jane Tiller
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
| | - Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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16
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Tiller J, McInerney-Leo A, Belcher A, Boughtwood T, Gleeson P, Delatycki M, Barlow-Stewart K, Winship I, Otlowski M, Keogh L, Lacaze P. Study protocol: the Australian genetics and life insurance moratorium-monitoring the effectiveness and response (A-GLIMMER) project. BMC Med Ethics 2021; 22:63. [PMID: 34020638 PMCID: PMC8138092 DOI: 10.1186/s12910-021-00634-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/12/2021] [Indexed: 01/01/2023] Open
Abstract
Background The use of genetic test results in risk-rated insurance is a significant concern internationally, with many countries banning or restricting the use of genetic test results in underwriting. In Australia, life insurers’ use of genetic test results is legal and self-regulated by the insurance industry (Financial Services Council (FSC)). In 2018, an Australian Parliamentary Inquiry recommended that insurers’ use of genetic test results in underwriting should be prohibited. In 2019, the FSC introduced an industry self-regulated moratorium on the use of genetic test results. In the absence of government oversight, it is critical that the impact, effectiveness and appropriateness of the moratorium is monitored. Here we describe the protocol of our government-funded research project, which will serve that critical function between 2020 and 2023. Methods A realist evaluation framework was developed for the project, using a context-mechanism-outcome (CMO) approach, to systematically assess the impact of the moratorium for a range of stakeholders. Outcomes which need to be achieved for the moratorium to accomplish its intended aims were identified, and specific data collection measures methods were developed to gather the evidence from relevant stakeholder groups (consumers, health professionals, financial industry and genetic research community) to determine if aims are achieved. Results from each arm of the study will be analysed and published in peer-reviewed journals as they become available. Discussion The A-GLIMMER project will provide essential monitoring of the impact and effectiveness of the self-regulated insurance moratorium. On completion of the study (3 years) a Stakeholder Report will be compiled. The Stakeholder Report will synthesise the evidence gathered in each arm of the study and use the CMO framework to evaluate the extent to which each of the outcomes have been achieved, and make evidence-based recommendations to the Australian federal government, life insurance industry and other stakeholders. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00634-2.
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Affiliation(s)
- Jane Tiller
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. .,Murdoch Children's Research Institute, Parkville, VIC, Australia. .,Victorian Clinical Genetics Services, Parkville, VIC, Australia.
| | - Aideen McInerney-Leo
- The University of Queensland Diamantina Institute, The University of Queensland Dermatology Research Centre, Brisbane, QLD, Australia
| | - Andrea Belcher
- Australian Genomics, Parkville, VIC, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Tiffany Boughtwood
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Australian Genomics, Parkville, VIC, Australia
| | | | - Martin Delatycki
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Victorian Clinical Genetics Services, Parkville, VIC, Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ingrid Winship
- Department of Medicine, University of Melbourne, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Margaret Otlowski
- Faculty of Law and Centre for Law and Genetics, University of Tasmania, Hobart, TAS, Australia
| | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Paul Lacaze
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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