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PubMed1996

Prognostic features of menopausal and postmenopausal applicants for life insurance.

The increasing proportion of the aged in the population is posing significant new challenges to politics, society and medicine as well. Gerontology and geriatrics are playing a role in all areas of preventive and curative medicine. Since the life expectancy of women is approximately eight years longer than that of men, gynecology draws special significance from the fact that the greater part of an aging society will primarily be comprise of women. The medical treatment and care of women in climacteric and postmenopause in the past is seriously inadequate by today's standards. The attitude in earlier years of not making any great investment of cost or personnel in patients over 75 can, in view of the vitality of modern-day senior citizens, no longer be justified or maintained. The necessity of establishing old-age gynecology becomes more and more clear and urgent. The decrease of ovarian function in menopause is without doubt an important turning point in the life of a woman. The first signs of aging are inescapable. Following these years a woman still has more than one third of life expectancy ahead of her which she would like to and should spend in good mental, spiritual and physical health. The principle of postmenopausal hormone replacement has shown itself to be amazingly successful in treating climacteric disorders and their effects on the entire organism. Treatment over many years with as board a spectrum as possible of preventive hormones to combat the long-term consequences of hormone deficiency, like osteoporosis-related fractures, heart attacks, or strokes, is one of the great medical advances of our time. Furthermore, the significance of preventing a number of genital concern manifestations through hormone replacement therapy cannot be overestimated. Gynecology has taken a remarkable step toward its goal of enabling aging women to spend the third part of their lives free of unnecessary diseases and suffering. In 1994, after consultation with representatives of European countries during the World Congress of the International Menopause Society, a statement was published by the menopause society of German-speaking countries. In this consensus paper, a stand was taken on hormone replacement therapy in postmenopause. The purpose of this paper was to serve as an aid in formulating and interpreting the text in the package inserts that are enclosed with hormone preparations. The most important passages were to once again summarize the present status of knowledge on hormone replacement therapy and its risks and benefits: (Estradiol is the estrogen normally produced by a woman's ovaries that exercises all functions of the natural follicle hormone. It is used to treat all symptoms of estrogen deficiency). Estrogen eliminates, or mitigates, all typical symptoms of estrogen deficiency in menopause, including hot flashes, night sweats and other complaints frequently observed like nervousness, sleep disturbance and depression, with great reliability. Estrogen stimulates the cell division of an aging organism, of mucous membranes, of supportive and connective tissue. It improves the blood circulation and the salt and water content. Furthermore, estrogen prevents or eliminates deterioration in the urogenital area and the disorders that result from such deterioration. Estrogen prevents or retards bone deterioration, osteoporosis and spinal, lower arm and femur fractures. By positively influencing HDL- and LDL-cholesterol, blood vessels and circulation, long-term estrogen replacement inhibits the development of arteriosclerosis and nearly halves the frequency of heart attacks and strokes. The mortality rate of women over 50 is therefore decreased significantly and life expectancy increased. (Benefits to the blood vessels of such preventive treatment can already be seen after five years of estrogen therapy and their benefits continue for several years after treatment is stopped.

Adult↗
PubMed1994

[Malignant melanoma in life insurance--thickness or anatomic layer?].

The incidence of malignant melanoma has tripled during the last 40 years and continues to increase. Among clinical criteria the single and most significant prognostic factor is the extent of tumor invasion expressed by thickness rather than anatomical structure. Patients with melanoma thinner than 0.76 mm have a five year survival of 96%. Thicker tumors bear a poor prognosis. Patients having survived 10 years have a life expectancy close to the normal population.

Cause of Death↗
PubMed1998

[Cause of death in life insurance].

In this study, mortality cases of a leading insurance company were collected over a period of several years and evaluated for the causes of death. In case of incorrect information given concerning the status of health, German rules and regulations allow an insurance company to resign from a contract only within the first three years. Because of this restriction, the cause of death is usually investigated during this period of time only. In Germany, unlike in many other countries, the official death certificate does not contain the cause of death, therefore the attending physicians have to be contacted for medical information. This rather costly and time-consuming procedure has to be limited to the three-year period. What seems to be at first glance an unfortunate restriction, turns out to be an enormous advantage at second glance. This three-year period can give excellent feedback about specific risks and trends of antiselection. Data of 1,549 persons dying within the first three years were evaluated. It turns out that cancer is the most common cause of death and cardiovascular diseases follow in second place. The underwriter and the consulting physician should keep in mind this surprising fact that tumors and not cardiovascular diseases play the most important role in life assurance. Unfortunately there are no such screening measures for tumors as we have at hand for cardiovascular diseases. Females have a lower mortality than males. Cross-sections show risks typical for certain age groups. In people under age 30, unnatural causes of death such as accidents and suicide cause more than two thirds of deaths. In the higher age groups, natural causes such as cancer and cardiovascular diseases become more and more important. In females cancer is even more important than in males, since they are less prone to die from cardiovascular diseases during the age period that is of interest to life assurance. The most common type of cancer in men was lung cancer and in females breast cancer. Trends of antiselection could be found in contracts with low sums assured, especially in older applicants. Our current practice of risk assessment can easily explain this phenomenon. For economical reasons, less time, money and effort can be spend on minor contracts than on those with high sums assured. On the other hand, it is unquestionable that a mandatory examination before offering life assurance coverage guarantees excellent risk assessment.

Age Factors↗
PubMed1984

The practical effect of obesity on the insured life--relative risks associated with obesity and various disease states--"the imparied life".

The 1979 Build and Blood Pressure Study was based on 4,200,000 North American life assurance policies issued after medical examinations between 1950 and 1971 and studied over the period of 1954 to 1972. The experience included 106,000 deaths. The study investigated the mortality experience of overweight lives assured by cause of death. Actual mortality was significantly above that expected for the following causes: diabetes mellitus, cerebrovascular disease, coronary artery disease and hypertensive heart disease. The implications of these observations are discussed.

Actuarial Analysis↗
PubMed1985

Evaluating corporate wellness and promotion programs: the cases of Johnson & Johnson Corporation and Metropolitan Life Insurance Company.

In 1983 the Health Systems Management Center of Case Western Reserve University (CWRU) contracted with the Business Roundtable Health Initiatives Task Force to use their survey of members as a guide to the top firms who had taken action regarding health care costs but, more importantly, who had also evaluated that action in terms of its cost implications. The mandate was to draw together representative case studies on seven firms who met those criteria for use in Business Roundtable (BRT) educational seminars and elsewhere. These cases may provide important insight for other companies who are contemplating action regarding their health care costs. They should also lead to further research on alternative actions available and the means of evaluation that should be considered. Most importantly they may provide some methodologies for top management to choose among proposals for attacking this burgeoning corporate cost. Two of the case studies presented here, Johnson & Johnson and Metropolitan Life, examine the area of wellness promotion and sickness prevention. Both of these companies believe that the employer can have a positive impact on employee health and thus corporate costs and productivity. Both also attempted to measure the benefit although Johnson & Johnson has made a significantly larger investment in this effort. The ongoing Johnson & Johnson evaluation does hold the greatest promise for measuring economic benefits. The limited results available are positive. Although financial ramifications are difficult to demonstrate, gains in employee morale are significant.

Cost-Benefit Analysis↗
PubMed2006

Making the normal deviant: the introduction of predictive medicine in life insurance.

Over the past years, one of the most discussed topics in policy debates on genetics has been the use of genetic testing in insurance. Many of these debates have been rather speculative and abstract. In a recent contribution to this journal, Kaufert therefore urged for "a proper research agenda" to study the issue, arguing for the need of anthropological and sociological research of the insurance world. This article will make a start with this. Based on ethnographic fieldwork in two Belgium insurance companies, this study analyses the ways insurers account for predictive medicine (lifestyle, genetics) during underwriting. We demonstrate how insurers highlight predictive lifestyle health information and how this articulates with a fault based approach in underwriting. Individual responsibility for health risks becomes the golden standard for assessing one's fitness for membership of the insurance pool. Moreover, these developments imply a changed concept of "normal standard" in insurance, increasing the conditions to fulfil to be part of the insurance group. Predictive medicine constitutes new ground in the old debates about individual control, responsibility and blame for health. This goes to the heart of the basis for citizenship and how this articulates with membership--or, if you want, exclusion--of the insurance pool.

Belgium↗
PubMed1985

Do the new Metropolitan Life Insurance weight-height tables correctly assess body frame and body fat relationships?

The 1983 Metropolitan weight-height tables include elbow breadth as a measure of frame size. Such tables assume that frame measures provide an estimate of fat free mass and have little or no associations with body fat. These assumptions were evaluated in 437 Canadian adults for six frame measures by their associations with total body measures of fat and fat free mass. All six frame measures were similarly correlated with fat free mass, even when associations with height were taken into account. Wrist and ankle breadths were not associated with total body fat, while shoulder, elbow, hip, and knee breadths were so associated. Thus wrist and ankle breadths satisfy the assumptions inherent in the frame-weight-height tables better than elbow breadth and the other frame measures investigated.

Adolescent↗