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Evaluating the effect of regulatory prohibitions against risk selection by health status on supplemental insurance ownership in Israel.

In Israel, supplemental insurance, which covers services not included in the mandatory basic benefits package, is offered by sick funds and regulated by the Ministry of Health. In 1998, policy regulations were set to eliminate barriers that prevented the ill from purchasing supplemental insurance, thereby increasing equality and risk solidarity. In this paper, we examine whether these regulations have indeed changed the extent of ownership and characteristics of policyholders, using data from surveys conducted in 1995, 1997, 1999, and 2001. The findings indicate that while there were no significant changes between 1995 and 1997, there was a significant increase in ownership among those with poor health status after the new regulations came into effect. We conclude that administrative regulations can influence the structure of supplemental insurance to achieve desired social values, and discuss additional policy options that are currently under debate in Israel to further promote equality and solidarity in this market by increasing accessibility to low income and other underserved populations.

Adult↗

Ethical implications of genetic testing for breast cancer susceptibility.

The identification of gene mutations involved in hereditary breast cancer is a major recent scientific discovery, enabling us to identify women at very high risk, and also providing the means to understand the biology of breast cancer and to explore novel preventive strategies. Yet, it carries medical, psychological, ethical and social implications. This paper is a review of all the ethical implications of genetic testing for breast cancer predisposition, as well as an attempt to discuss the more philosophical questions of women facing BRCA testing. To what extent does the individual benefit from genetic knowledge? Some women look with trepidation upon the potential of planning their life in view of a risk, while others believe that only through knowledge and awareness we can improve control of our life. The risk of breast cancer may be qualitatively so important to justify all the potential risks of finding out about it.

Adoption↗

Premium variation in the individual health insurance market.

Recent proposals to decrease the number of uninsured in the U.S. indicate that the individual health insurance market's role may increase. Amid fears of possible risk-segmentation in individual insurance, there exists limited information of the functioning of such markets. This paper examines the relationship between expected medical expense and actual paid premiums for households with individual insurance in the 1996-1997 Community Tracking Study's Household Survey. We find that premiums vary less than proportionately with expected expense and vary only with certain risk characteristics. We also explore how the relationship between risk and premiums is affected by local regulations and market characteristics. We find that premiums vary significantly less strongly with risk for persons insured by HMOs and in markets dominated by managed care insurers.

Adolescent↗

Genetics and insurance in Britain: why more than just the Atlantic divides the English-speaking nations.

The British Government's official advisory committee on genetics has recommended a moratorium on the disclosure of genetic test results for life insurance until predictions based on such tests can be validated as actuarially important. In contrast, the trade association of the British insurance industry believes that genetic tests relating to eight conditions can yield information useful for life insurance. Although the Government has yet to respond, the debate is already moving on to genetic testing and the funding of health care for the elderly.

Advisory Committees↗

Whose right to genetic knowledge?

A new section in this issue of Nature highlights the growing demands of insurers for access to genetic information, the diversity of legislative responses, and the many scientific uncertainties. The history of genetics suggests a controversial way forward.

Confidentiality↗

Gene tests: who benefits from risk?

The insurance industry is likely to find it more difficult to use genetic data on disease susceptibility than some of its critics claim. But it is already contesting demands for strict controls on the way this data is used.

Ethics, Medical↗

Touching base.

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Animals↗

Vital data.

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BRCA1 Protein↗