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PubMed1990

Deontological aspects in recombinant DNA researches.

Legal problems exist in regard to patent rights for new biotechnologies. Ethical problems arise in connection with the application of the technique to patients and with the possibility to cure embryos. The potentialities of preventive medicine have affected even hiring criteria, in that individuals who present enzymic deficiencies can be considered at risk when working in contact with certain substances. For example, firms could decide not to advance certain individuals to positions of responsibility on the grounds that they present the gene of familial hypercholesterolemia. It can be anticipated that the diagnostic potentialities of the recombinant DNA technique will be applied to the evaluation of risk for the stipulation of life insurance, and that further developments, permitting to determine the genetic predisposition for most diseases, would altogether nullify the basic principles of health- and life-insurance policies. An international committee will have to discuss these issues and to formulate deontological rules to regulate both the sphere of occupation and that of insurance.

Biotechnology↗
PubMedDate not supplied

The effect of firearm deaths on life expectancy and insurance premiums in the United States.

Despite recent gains, the U.S. remains behind most other affluent countries in life expectancy. Even within the U.S., the gap between the life expectancies of Caucasians and African-Americans remains significant. At the same time, firearm deaths in the U.S. far exceed peer nations, and disproportionately affect African-American males. In this Issue Brief, Dr. Lemaire explores whether deaths from firearms explain some of these international and racial disparities in life expectancy. He uses actuarial techniques to calculate the "cost" of firearm deaths in the U.S., both in terms of reduced life expectancy and increased life insurance premiums.

Actuarial Analysis↗
PubMed2003

Insurance, employment, and psychosocial consequences of a diagnosis of hereditary hemochromatosis in subjects without end organ damage.

OBJECTIVES: Asymptomatic individuals with hereditary hemochromatosis (HH) may experience difficulties in obtaining employment or insurance, despite their good health. The extent to which these difficulties occur is unclear. The aim of this study was to assess the insurance, employment, and psychosocial consequences of a diagnosis of HH in subjects with no end organ damage. METHODS: In three outpatient clinics specializing in the treatment of HH, we performed a survey of individuals diagnosed with HH who were without end organ damage secondary to iron overload, along with their unaffected siblings. A review of the medical records of subjects with HH was performed. Main outcomes were attaining and keeping employment; health, disability and life insurance; and scores on the SF-36, a quality of life measure, and the SCL-90-R, a measure of psychological well-being. RESULTS: Of 130 eligible subjects with HH, 126 (97%) responded. Of the 55 eligible controls, 46 (84%) responded. Of the 126 subjects with HH, 25 (20%) described 28 incidents of insurance denial or increased premium rates, which they attributed to their diagnosis HH. Of the 28 incidents, 16 (57%) involved life insurance, eight (29%) involved health insurance, and four (14%) involved disability insurance. One subject reported an employment refusal. Five of the 25 subjects (20%) reporting insurance denial or increased premiums had significant comorbid conditions. One of 46 sibling controls (2%) reported an increased rate for life insurance (p = 0.003). No differences were noted in either the SF-36 or the SCL-90-R scores between subjects with HH and unaffected siblings. Overall rates of active health, disability, and life insurance were similar between the groups. CONCLUSIONS: Insurance denial and increased premium rates are reported commonly among individuals with HH without end organ damage. However, the overall proportion of those with active insurance, the quality of life, and the psychological well-being of these subjects were similar to those of unaffected siblings.

Adult↗
PubMed1984

Insurance and the disabled.

The provision of life insurance for the disabled has been investigated to determine the extent to which the perceived disadvantage expressed by some disabled groups was real and, if real, justified. Life cover for a particular disability is likely to be offered only by the few companies with experience of it; however, the ratings charged appear usually to be a fair reflection of the limited and often poor information available. The response of organizations for the disabled to this problem has been reviewed, and possible strategies to enable the disabled to obtain insurance are suggested.

Actuarial Analysis↗
PubMed2006

Comparing knowledge and attitudes towards genetic testing in Parkinson's disease in an American and Asian population.

INTRODUCTION: Recent discoveries of disease-causing genes in Parkinson's disease (PD) have generated considerable interest regarding genetic testing in PD. The attitudes toward genetic testing are largely influenced by knowledge and preconceived notions. OBJECTIVE: We investigated the relationship between knowledge of and attitude towards predictive genetic testing of PD in two independent centers in America and Asia involving PD patients and caregivers. METHODS: In a prospective study involving 515 subjects comprising of PD patients and their caregivers in two independent centers in America and Asia, the level of knowledge about genetic testing and patients' attitudes towards such testing were evaluated using a standardized questionnaire. RESULTS: American PD patients had a higher level of knowledge of PD genetics than Asian PD (31.1% vs. 12.3%, p=0.0002). A greater number of American PD patients and caregivers reported a positive attitude towards the potential medical benefits of genetic testing compared to their Asian counterparts (85.4% vs. 42.2%, 92.2% vs. 32.1%, p<0.00005), but a more negative attitude towards potential compromise in getting health and life insurance (43.7% vs. 25.8%, p=0.0002). However, in the Asian cohort, multivariate analysis revealed that a high level of genetics knowledge was associated with a positive attitude response regarding the potential medical benefits of testing (p<0.0005), but a negative attitude towards compromises in healthcare and life insurance, getting a job and starting a family (p<0.0005). These associations were not observed amongst American subjects. CONCLUSIONS: The relationship between level of genetic knowledge and attitude towards potential risks and benefits of predictive genetic testing in PD was distinctly different in two independent, racially and culturally different PD populations and caregivers. These observations have clinical implications in the development of PD genetic counseling programs.

Adult↗
PubMed2006

Breast cancer among Asian Americans: is acculturation related to health-related quality of life?

PURPOSE/OBJECTIVES: To examine the association of acculturation with health-related quality of life (HRQOL) among Asian American breast cancer survivors. DESIGN: Cross-sectional. SETTING: Analysis of an Asian American subsample of breast cancer survivors from a larger multiethnic study. SAMPLE: 206 Asian Americans, including Chinese, Filipinos, Koreans, and Japanese. Most were diagnosed with early-stage breast cancer (stage 0-II) and were an average of 54 years old. METHODS: Participants completed a mailed questionnaire or answered a telephone survey in English, Mandarin, or Korean. HRQOL was measured using the Functional Assessment of Cancer Therapy Breast Version 4. Acculturation was measured using an eight-item scale adapted from Marin's Short Acculturation Scale. MAIN RESEARCH VARIABLES: HRQOL, acculturation, health insurance, life stress, and social support. FINDINGS: Acculturation was significantly associated with HRQOL when demographic, medical, socioecologic, and healthcare access factors were controlled. However, the significant association between acculturation and HRQOL disappeared when Asian subgroup membership was considered. Subgroup differences in HRQOL remained after controlling for covariates, with Korean Americans reporting lower HRQOL than the other Asian American subgroups. CONCLUSIONS: The absence of a significant association between acculturation and HRQOL in the final model is likely a result of the strong association between acculturation and Asian American subgroup membership. The results suggest that the correlation between acculturation and HRQOL is not an effect of having health insurance, life stress, and social support. IMPLICATIONS FOR NURSING: Closer attention is needed regarding acculturation level; Asian American subgroup differences, including language capacity; and socioecologic characteristics in nursing practice and research.

Acculturation↗
PubMed1997

Tumor marker study: the Transamerica experience 1990-1995.

BACKGROUND: From the fall of 1990 through January 1995 Transamerica Occidental Life screened applicants for life insurance for cancer with Tumor Associated Antigen (TAA). RESULTS: 110,299 applicants were tested and in 13,829 positive levels of TAA were found. Of this latter number, 255 applicants were declined following various levels of evaluation. CONCLUSIONS: We concluded that TAA screening was neither sensitive, nor specific enough for a screening tool for life insurance.

Actuarial Analysis↗
PubMed1978

[Insurance system. Prevention from viewpoint of the insurer].

The purpose of an insurance must not be restricted to the payment of claims to those insured persons who suffered a loss, for loss prevention is much preferable to claim settlement. A whole range of different institutions and measures has been established by the Swiss insurers, in which many insurance branches participate. The loss preventing activities can be listed as follows:--Activities of the fire insurers to prevent and fight fires. This is the prevailing duty of the Consulting Agency for Fire Prevention (BfB) as well as the Fire Prevention Service for Industry and Trade (BVD).--Activities of the accident insurers to prevent accidents. The fight against accidents, mostly traffic accidents, in sports and at home is the foremost task of the Swiss Council for the Prevention of Accidents (BfU), an institution created by the Conference of Accident Insurance Managers (UDK) and the Swiss National Accident Insurance Fund (SUVA).--The Health Service in life insurance, after all the periodical medical examinations and consultations granted by many insurers to their insured persons, as well as the pamphlets aiming at health education published by several Companies and finally institutions and measures to promote fitness, e.g. VITA-Parcours.

Accident Prevention↗
PubMed2002

[Social concern and independence in adults with congenital heart disease].

OBJECTIVES: Recent advances in medical and surgical treatment have led to the survival of increasing numbers of adults with congenital heart disease (CHD). However, the social status of these patients remains unknown. This survey investigated the social prospects for adults with CHD, and the limiting factors for social independence. METHODS: A written questionnaire on patient characteristics, education, employability, marital status and insurability was designed to define the characteristics of social independence in adults with CHD. Randomly selected adults with CHD were enrolled: 13 patients with cyanotic unrepaired CHD (4 males, 9 females, mean age: 29.8 +/- 10 years, range: 18-56 years) and 102 patients with other CHDs (48 males, 54 females, mean age: 29.5 +/- 10 years, range: 18-74 years). RESULTS: University of California at Los Angeles functional class I-II was found in 94% of patients, medication in 46%, and hospitalization in 51%. Compared with the data from Japanese general population, study patients had a lower ratio of high school graduates (86% vs 94%), life insurability (51% vs 71%), marital status (31% vs 32%) and employability (82% vs 80%). Patients with unrepaired cyanotic CHD had significantly lower ratio than those with other CHDs (marital status 15%, p = 0.19; employability 40%, p = 0.0003; high school graduates 69%, p = 0.06; life insurability 18%, p = 0.02, respectively). CONCLUSIONS: Factors affecting social independence in adults with CHD were severity of disease, continuing medication, lower level of education, lower self-esteem, and unknown natural history of CHD. To improve social independence in these patients, further development of medical and surgical therapy and more detailed knowledge of the patients, caretakers and society in this field are needed.

Activities of Daily Living↗
PubMed1992

Life expectancy in patients attending multiple sclerosis clinics.

One multiple sclerosis (MS) is diagnosed, important considerations often include life expectancy and the availability of life insurance. We designed a study specifically to examine life expectancy among MS clinic patients and analyzed the data using standard actuarial methods, both including and excluding suicides. The data show that severe MS disability, as measured by an Expanded Disability Status Score (EDSS) of greater than or equal to 7.5, is a major risk factor for death with case fatality ratios for this group of patients approaching 4 times the rate for controls. Conversely, excluding deaths by suicide, case fatality ratios for those with mild and moderate disability (EDSS less than or equal to 7.0) approach 1.4 times and 1.6 times for age- and sex-matched comparison groups. Life tables indicate that the overall life expectancy for MS is only about 6 to 7 years less than that for the "insured" population without MS.

Adolescent↗
PubMed2006

Better quality of life among 10-15 year survivors of Hodgkin's lymphoma compared to 5-9 year survivors: a population-based study.

This study describes the quality of life (QoL) of long-term Hodgkin's lymphoma survivors and compares it to an age-matched normative sample. The population-based Eindhoven Cancer Registry was used to select all patients diagnosed with Hodgkin's lymphoma from 1989 to 1998. Eighty percent of survivors completed the SF-36 and the quality of life-cancer survivors questionnaire. QoL was better among patients diagnosed 10-15 years ago compared to patients diagnosed 5-9 years ago. The patients diagnosed 5-9 years ago experienced lower general health, social functioning, mental health and vitality compared to an age-matched normative sample, while the patients diagnosed 10-15 years earlier reported lower general health but better physical functioning. Most patients reported that their work situation did not change. Problems pertaining to the obtainment of health insurance, life insurance and mortgages were high. QoL among Hodgkin's lymphoma survivors is lower compared to an age-matched normative sample. Survivors furthermore experience some (financial) problems in the years after diagnosis.

Adult↗
PubMed2001

Alcohol abuse and liver enzymes (AALE): results of an intercompany study of mortality.

Evaluation of applicants for life insurance who have elevations of their liver function tests or an increased probability of alcohol abuse has always been difficult for underwriters. This paper reports the results of an intercompany study in which the pooled mortality experience of a group of insureds with evidence of alcohol abuse, an adverse driving record or elevations of the liver transaminases or gamma-glutamyl transferase is summarized.

Adult↗
PubMed1997

Estimated cost of person-Sv exposure.

The present paper summarizes work performed under contract to the Department of Energy and reported separately. This paper covers efforts to define a cost per person-Sv by determining a value for a societal life and coupling the result with the probability of death due to radiation exposure. The value of a societal life was estimated by examining wrongful death awards and settlements, amounts taken out in life insurance, amounts spent in the last year of life for the critically ill, lifetime earnings and investments, and other approaches and values found in related literature. The values of a societal life ranged from $600,000 to $7,000,000, with a value of $4,000,000 considered by the authors as a conservative average in terms of 1990 U.S. dollars. The associated costs per person-Sv thus determined were found to range from $18,000 per person-Sv to $630,000 per person-Sv ($180 per person-rem to $6,300 per person-rem), with a value of $200,000 per person-Sv ($2,000 per person-rem) taken as a conservative average.

Consumer Product Safety↗
PubMed1997

The likely financial effects on individuals, industry and commerce of the use of genetic information.

In this paper I look at the financial implications of genetic testing, particularly in the employment and pensions fields. I have generally not covered life insurance, as that is covered in other papers in this Discussion Meeting. However, the issues are similar, although the emphasis is different. Inevitably there is an element of speculation involved; genetic testing is in its infancy and so we cannot predict either what information we will be able to obtain through genetic testing, nor the uses that may be devised for this information.

Adult↗
PubMed2003

Health plans--enforcement of right to reimbursement not available under ERISA section 502(a)(3). Great-West Life & Annuity Insurance Company v. Knudson.

The United States Supreme Court reaffirmed its reluctance "to tamper with [the] enforcement scheme" embodied in ERISA by authorizing remedies not specifically authorized by ERISA's text, and held that section 502(c)(3) does not authorize a plan to bring an action to enforce the plan's reimbursement provisions because recovering monetary damages for reimbursement is not relief typically available in equity and, therefore, is not "other equitable relief" within the meaning of section 502(a)(3). An action to impose personal liability on the Knudsons for a contractual obligation to pay money is an action seeking legal, not equitable, relief and is not authorized by section 502(a)(3).

Employee Retirement Income Security Act↗
PubMed2000

Estimating the national cost of treating people with HIV disease: patient, payer, and provider data.

OBJECTIVE: Existing estimates of the national cost of treating all people with HIV disease use data from a sample of people with HIV disease to extrapolate the cost of treating all people with HIV disease (patient-based approach). This study derives estimates using two novel approaches (i.e., payer-based and provider-based) and compares these with existing estimates. DATA SOURCES: These include the Health Insurance Association of American and the American Council of Life Insurance 1996 HIV survey, the 1996 State Inpatient Databases (SID) maintained by the Agency for Healthcare Research and Quality, and the IMS America Ltd. survey of independent and chain drugstores. PRINCIPAL FINDINGS: The cost of treating all people with HIV disease in 1996 was between $6.7 and $7.8 billion U.S., and the average annual cost of treating a person with HIV disease was between $20,000 and $24,700 U.S. CONCLUSIONS: Analysts should derive estimates of the cost of treating people with HIV disease using several different approaches. K

Costs and Cost Analysis↗
PubMed1986

"Insanity" in civil law.

The issue of "insanity" is rarely alluded to in the area of civil law. As a consequence, the legal standard for insanity is not clearly understood by many psychiatrists. The standard derives from case law and is based upon statutory law in the criminal sector. A civil case will be presented where the question of "insanity" was raised. In this case an individual committed suicide and his insurance company refused to pay the beneficiaries of his life insurance policy based upon a provision in his policy that excluded payment in situations of suicide. His beneficiaries sued, claiming that the deceased was insane at the time of his suicide and therefore not responsible for his actions. The standard for insanity in New Jersey and the reasoning of the psychiatrists will be presented.

Expert Testimony↗