ASSURANCE MEDICAL SOCIETY 2006

1
ASSURANCE MEDICAL SOCIETY 2006

• HANDLING MEDICAL DATA WITHIN COMPANIES
• Richard Walsh
• ABI Head of Health

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HANDLING MEDICAL DATA CURRENT ISSUES

• HIV Civil Partnerhsips
• Fees negotiations and new targetted reports
  very topical so covered in some detail
• Genetics
• Role of medical advisers and the CMO
• Conclusions

3
HIV

• New Statement of Best Practice implemented
  30/9/05
• New expert working group set up
• No discrimination against gay men, only risky
  behaviours
• Within the last 5 years, have you been exposed
  to the risk of HIV infection?
• Still ask questions about residence etc in
  country with high HIV prevalence

4
Current terms of reference from Statement of
Best Practice

• To inform further policy development
• Issues likely to be addressed are
• The evidence base for HIV risk
• Changing cultural attitudes and encouraging
  responsible behaviour
• Rational and respectful decision making
• Fair ratings
• Likely initial work programme
• Civil partnerships
• A consumer guide(s) for those people at higher
  risk of developing HIV
• Develop more guidance on group insurance
• Develop policy on new Coroners procedures and
  death certificates

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Civil Partnerships

• Took advice from HIV Expert Group met 15
  November you heard it here first
• Comes into effect in December and Equality Bill
  now covers good and services
• Guaranteed insurability, motor and household
  all to do with married status not HIV risk so
  equal treatment?
• HIV risk
• cigma study of gay men considering evidence
• market is moving anyway.

6
Civil Partnerships

• Options
• Test men in civil partnerships at the same level
  as married men (some companies have already
  started to move to this stance)
• Continue to test men civil partnerships at the
  same level as single men
• ABI response sustainable???
• Allow insurers a free choice on their response
  regarding HIV testing limits and the CPA. This
• allows applicants the opportunity to shop around
  for the best deal
• is consistent with previous refusals to make
  recommendations on financial testing limits
  because of competition law.

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Civil Partnerships

• Issues
• The expectations of those entering into Civil
  Partnerships
• Whether treating those in Civil Partnerships
  differently from those in traditional marriages
  can be supported statistically (based on HIV
  risk) for testing purposes

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FEES - HISTORY

• Current fees (2005 agreement)
•  
• GPR 70.50 8.5 (from I July)
• GPR Supp - 18.00 9.1
• Med Exam - 77.50- 9.2
•  
• Historic Increases
•  
• 2004
• GPR 65 8
• GPR Supp 16.50
• Medical Exam 71.00 7.5 NB yearly figure
  less because of implementation date carried
  forward in 2005
•  

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FEES - HISTORY

• 2003
• GPR 60 11
• GPR Supp 15.75
• Med Exam 66 10
•  
• 2002
• GPR 54 74
• GRP Supp 15
• Med Exam 60
•  
• Prior to 2002 agreement
•  
• GPR 31 free market increasing numbers paying
  well over this. BMA refused offer of rise to 45

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FEES NEGOTIATIONS

• Dynamisation factors
• 2003/2004
• Interim estimate (90 confidence) 7.2
• Estimate8.8
• Actual not yet known?
• 2004/2005 2005/2006
• Interim estimate 6.1 Interim estimate 7.3
• Estimate 10.8 Estimate 12.00
• Actual not yet known Actual not yet known?
• 2006/2007
• Interim estimate????
• Estimate????

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FEES - NEGOTIATIONS

• In theory the 2006 GPR negotiating round
  calculations should be straightforward ie
• The difference between the estimate and interim
  figure for 2005 12 - 7.3 4.7 plus the
  interim figure for 2006.
• We have been in contact with Department of
  Health about the 2006 figure and have been
  advised that this may not be known for some time.
  We also know that DH and HMT are seeking to limit
  the figure in line with average earnings or less.
• BUT THE CURRENT AGREEMENT ALSO SAYS..

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FEES NEGOTIATIONS

• Once the actual Dynamisation Figures are known
  for 2003/04, 2004/05 and 2005/06 these will be
  presented as part of the negotiations for an
  uplift of the 2007/08 rates.
• At this point the ABI and BMA will seek to reach
  an agreement on how to handle the difference
  between the annual uplifts previously agreed
  (2003/04, 2004/05 and 2005/06) and the uplifts
  that would have been agreed if the actual
  Dynamisation Factor had been known. The scale of
  the difference will be acknowledged and adjusted
  for in terms of fees for 2007/08 and 2008/09
  according to when the figures are actually known.

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FEES NEGOTIATIONS

• So if the actual dynamisation figures turn out
  to be significantly higher than the estimated
  ones we have a problem
• Plus 2007 is when all forms will attract VAT.
• A real challenge for medical evidence so we need
  to look at alternatives

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TARGETTED REPORTS

• The ABI is proposing to produce guidance on the
  format, content and use of targeted GP reports by
  insurers.
• These reports can be used as an alternative to
  GPRs in certain circumstances. They are not
  intended to replace GPRs or supplementary GPRs.
  Instead they offer an alternative solution where
  an insurance applicant has declared specific
  conditions that the insurer requires more
  information on

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TARGETTED REPORTS

• Unlike the full GPR, a targeted report
  will collect information on one particular
  condition only. The aim of targeted reports will
  be to
• reduce the burden on GPs by significantly
  reducing the amount of information they  are 
  asked to provide to insurers
• allow insurers to ask questions targeted to an
  individual's circumstances
• help ensure that only relevant information is disc
  losed
• improve turnaround times
• improve the quality of underwriting decisions to
  the benefit of consumers
• Good fit with tele-underwriting
• BUT HOW MUCH??? ARE THEY EFFECTIVE..

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TARGETTED REPORTS NU PILOT SURVEY
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Genetics skimming the surface

• Developments potential and actual
• The moratorium

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Developments in genetics
Trend
Possible impact
Influence on health insurance
Increased detection of single gene disorders

• Reduced incidence of conditions
• Improved treatment

• Reduced claims?
• Possibly, more people alive to apply for insurance

Increased understanding of genetic basis of
familial cancers

• Increased awareness of risk and demand for
  screening
• Increased screening in at risk groups
• Increased availability of prophylactic measures

• Earlier detection of disease
• Reduced mortality
• Need to consider approach to insurance for people
  with regular screening and/or measures to reduce
  risk

Increased understanding of genetics in common
conditions

• Increased awareness of impact of genetics
• Increased awareness of own profile

• Potentially greater adoption of healthy
  behaviours to reduce risk
• Non disclosure

Increased use of gene-tailored treatments

• Improved survival rates
• Increased differentiation depending on genetic
  make up

• Improved treatments resulting in improved health
  status
• (Different insurance risk profiles)

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THE UK MORATORIUM

• Extended to 1 November 2011
• No use of predictive genetic tests results to
  underwrite travel insurance, private medical
  insurance, or any other one-off or annual policy,
  or for long term care policies.
• Customers not be asked to
• undergo a predictive genetic test in order to
  obtain insurance
• disclose another persons predictive genetic test
  results
• disclose any predictive or diagnostic genetic
  test results acquired as part of clinical
  research
• disclose any predictive genetic test results that
  are made available after their policy has
  started, for as long as that policy is in force

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SO WHAT HAPPENED?

• Even single gene mutations proved more
  complicated including HD
• Not many people take tests
• Tests tend not to be used if no treatment
• Multifactorial majority nowhere near enough
  progress for insurance implications to be
  calculated

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2003 NHS FIGURES FROM UK
22
2003 NHS FIGURES FROM UK
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ABI COMPLIANCE 2003 FIGURES - HD

• 70 of normal results were accepted at ordinary
  rates lower than rest of population due to
  health profile of families with HD?
• Total of 21 HD ves. Most loaded. Of those 2 were
  for over 500k companies which ignore all
  predictive tests
• Of 18 loaded 78 were loaded because of other
  health factors
• Similar data for BRCA12
• But no predictive test yet approved

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• So from a consumer and insurer perspective
• It is a complex picture
• Even for HD more likely to be rated for non-HD
  factors than genetics
• Insurance is still available from some companies
  above moratorium limits
• Overall numbers of genetic tests are very small

25
Genetics applications to GAIC

• BRCA1 and BRCA2 for life and CI
• No plans to resubmit for Early Onset Alzheimers
  or for LTCI

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ROLE OF CMO

• TRADITIONALLY the CMOs duties include
• Contributing to the development of the companys
  underwriting philosophy and practice.
• Advising the Chief Executive and Chief
  Underwriter in relation to the companys policy
  on confidentiality and security of clinical
  information.
• Liaising with medical examiners and medical
  advisers.
• Providing medical training for underwriters.
• Providing expert advice to the underwriter on
  complex cases.
• Providing expert advice on medical documentation
  to the insurer
• Keeping the insurer abreast of major medical
  advances, including those in the areas of genetic
  science and technology.
• Providing expert medical advice on claims, when
  there is a dispute, or when irregularities are
  suspected.
• Exercising his or her judgement on issues of
  medical ethics.

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ROLE OF CMO

• But today many companies do not operate this
  model. Instead they use a panel of doctors
  referrals to re-insurance doctors
• Question for debate how can companies ensure
  that medical policy is coherent?

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CONCLUSIONS

• Ethical issues for example HIV, genetics, medical
  confidentiality remain complex and changing with
  changing society
• GPR model passing sell by date???
• Role of CMO and gathering/handling medical
  information needs more thought