Testing for life

Carcinogen bound in DNA double helix (image courtesy of www.pdimages.com)

Should insurers be able to use knowledge of someone’s genetic make-up before they sell them a premium? Yes (with some restrictions), says the insurance industry.

Over the last decade, scientists have made significant progress in identifying the gene mutations that increase the risk of disability or death. For example, if tests reveal that a woman has the BRCA1 or BRCA2 mutation, she has a significantly higher risk of both breast and ovarian cancer.

An insurer might feel justified in charging twice the normal premium for life insurance, and might not want to offer disability insurance at all.

The Investment and Financial Services Association, the life insurance industry body, has, however, addressed such issues. It now has a policy which allows insurers to request access to genetic test data if it has already been gathered. But the insurer can’t require a person to take a test, or use information about one family member to underwrite others. The data is also subject to strict privacy regulation.

Public policy issues

The kinds of questions this debate raises, says Shauna Ferris, Senior Lecturer in the Department of Actuarial Studies, are important for the development of good policy in this tricky area.

They include: Will people be discouraged from taking genetic tests which might help them stay healthy, for fear of consequences for jobs and insurance? Is it fair to charge extra premiums for something not under a person’s control? and Will a genetic underclass of the non-insurable develop?

What happens in other countries?

The United Kingdom and other European Union countries have banned the use of genetic test data for insurance underwriting, up to a certain sum (500,000 pounds in the UK).

The UK has also imposed standards to make sure that if genetic data is used to insure for larger sums, decisions are scientifically based.

In the United States, debate centres on access to health insurance. In Australia, health insurers charge premiums based on “community rating”. This means that insurers can’t charge a higher premium to a higher-risk person.

In this country, the Australian Law Reform Commission and National Health and Medical Research Centre were commissioned by the government to conduct an inquiry. It suggested setting up a Human Genetics Commission to advise on setting up procedures to assess the scientific reliability and actuarial relevance of genetic tests. This will lead to research requiring collaboration between actuaries, underwriters and medical researchers. Macquarie Honours student Katelyn Priester wrote her thesis on modelling the extra mortality arising from Huntington’s Disorder.

Shauna Ferris herself is on a review committee surveying what life insurers are doing to determine numbers of applicants for insurance who have had tests, the most common disorders, and the effect of this on customers’ insurability. She is working on developing a model for the effect of different legislative restrictions on genetic testing.

For further information, contact Shauna Ferris at shauna.ferris@mq.edu.au or visit the Department of Actuarial Studies website at www.acst.mq.edu.au

More Health stories here