The “forecasting” issue of Broker World wouldn’t be complete without a look into the future of medical underwriting. Will a person come to our house, swab the inside of our cheek, and be done with the medical end of things? Will we step into a machine that records height, weight, lean body mass and then proceed to CT scan our entire body? And even if they could, would we let them? The sky may be the limit, but we as a government and privacy protective population may not let it get that far.
If you grew up watching “The Jetsons”, what really hasn’t come true in the years since the cartoon was on the airwaves? Maybe not flying transport saucers through space or vacations on Mars, but an awful lot. You can step into one of those machines and have everything from coronary calcium to every body organ scanned and outlined. You can have blood analyzed for almost anything, and now genetic prediction of what will happen in the future. You can have doctors diagnose you by Smartphone and remote television from virtually anywhere. You can have physicians doing surgery not even standing in the same room as the patient.
In the rather recent past, certainly in the 25+ years I have been writing this column for Broker World, requirements in underwriting have certainly changed. Chest X-rays, almost routine in large amount cases, are almost obsolete as a requirement for any applicant. Treadmill exams, done at specific age and amounts without cause, are not really done now except for cause, and the standard of medicine has changed so that if there is cause, the likelihood such testing (and more) will already be part of the APS is high. MD exams, an integral part of even applications of as low as half a million dollars previously, are now the exception rather than the rule. As Bob Dylan forecast, “The times, they are a-changin’…”
Blood requirements currently available tell us more than ever before. Before we could tell if liver function tests were up—now we can obtain any serology to tell us what’s causing the elevation and why. A blood marker, BNP, is starting to be used and advocated in place of EKGs in routine screening for many companies. Paramedicals now perform almost every task in collection and obtaining data instead of physicians. So much more is available to us in “routine” care that we are virtually up-to-date without age and amount requirements at times. We can even obtain pharmacy data that allows us to know every medicine that was prescribed by your doctor without getting the actual records.
Genetic testing is now at the forefront of research. You can mail a sample to a testing facility independent of a request from your doctor and find out your likelihood of developing (or even having in the current) one of 1,000 diseases—and that list expands yearly. We are on the verge of walking into a neighborhood drugstore for just a finger prick and being able to have at our disposal every test a doctor would have normally had to order on a physician visit. Newer applications developed by testing companies can feed every lab result into a vast array of experience data and find out where you stand in mortality without even additional testing—imagine being rated for a life insurance policy when every result is “normal” because the combinations of how normal they are will experience-rate differently.
With all that being said, medical underwriting is unlikely to move much more quickly than the field of medicine does itself. Convenience has become the key word, and making it easy for the applicant to get a product (perhaps as easy as ordering a product on Amazon) is the eventual goal. However, there are fail-safes that will prevent the cart from getting ahead of the horse which will limit insurers’ ability to get too cutting edge in the immediate future.
Insurers are allowed to obtain quite a bit of information in underwriting for a life insurance policy. Your height, weight (who else in your life knows that?), vital signs, laboratory work, and everything your physician knows about you are available in underwriting. Consent for testing for even sensitive tests like HIV and hepatitis C are part of the signed consent. Urine screens for drugs and your whole prescription history is available. That’s an awful lot, and allows insurers to predict mortality and morbidity well enough to design competitively (and now more conveniently obtained) policies for the public. The information is sensitive and protected, and government regulations make it stay that way.
What will limit it is truly what the public allows insurers to know or how much privacy they wish to protect in the process. If insurers actually have a test that tells them if you will develop Alzheimer’s for instance, do you want them to have this information? Maybe more telling: do you want to know this information? An insurer may promise not to tell you the result, but you draw the conclusion when you think you are fine and a company rates or declines your application without telling you why. Yes, we want to be screened for cancer and have doctors know what will happen if a condition is left untreated and for it to be cured before it is too late. No, perhaps we don’t want to know when we die, what of, and how. Or want someone else to know that either, with or without a complicity to warn or the ability to take action on it—the “secret” result. If an insurer pushes for too much information, the golden goose may be strangled and the government may not allow it to have even the information it is already able to gather. Then what happens to pricing and prediction?
Insurers are also going to have their work cut out for them the more information that comes out to the public that they are not privy to. If you find out an adverse result in obtaining genetic testing, will you tell the insurer? If blood testing you get in a pharmacy is abnormal, will it be disclosed? Will the insurer lose the sentinel effect, not being able to run the same test an applicant can and then finding a slew of individuals with a particular disease suddenly applying for insurance?
In the near future medical underwriting will continue to advance, but likely not much faster than the state of the art of general medicine itself. Sure, if a specialized CT scan or genetic procedure is done by a physician, the insurer will have access to it and the ability to underwrite the result appropriately. But the public being able to understand the processes an insurer uses to arrive at a conclusion or policy rate has to be transparent to the applicant, the applicant’s doctor and essentially everyone who has a legal right to the information. If information available to the applicant that is adverse leads to higher claims and adverse outcomes, no one wins, as the price of the policy just increases for all concerned (especially the healthy). In health care, there may be arguments as to the right of everyone to coverage—life insurance is more discretionary in its purchase. For that reason medical underwriting is likely to move in lockstep with medicine in general—information becoming as convenient to obtain for the applicant as possible without anti-selection influencing the overall outcome for all successful insurers in the field.
