GENETIC TESTING AND THE ECONOMICS OF LIFE INSURANCE

该项目的目的是评估在保险公司无法获得女性基因测试结果的情况下，检测BRCA1和BRCA2突变对人寿保险合同成本和价格的可能影响。随着公众接受有助于预测未来疾病状态的基因测试的机会增加，保险业越来越担心其财务偿付能力将受到威胁，除非它也可以获得对个人可用的相同基因信息。这种威胁以“逆向选择”的形式出现。那些通过基因测试得知自己有更高的死亡或疾病风险的女性可能会购买更多保险。如果保险公司无法获得测试结果，他们就更难识别哪些人面临高风险，哪些人没有高风险，因此他们无法适当调整保费价格。理论上，在这种情况下，寿险市场可能会消失，导致没有人能获得保险的情况。许多保险业代表指出，逆向选择理论是制定新法规的理论基础，新法规可能要求保险业也向该行业提供个人可获得的所有基因信息。这一“公平竞争环境”的要求与消费者和患者群体加强基因信息隐私保护的相反努力形成了鲜明对比--主要是因为担心这将导致保险业认为对其偿付能力至关重要的那种歧视。关于这一问题的当代辩论将妇女在隐私方面的合法利益与保险公司在财务偿付能力方面的合法利益对立起来。除了花言巧语和轶事之外，几乎没有什么实证工作可以推动这些辩论，但它们是最近十几项涉及遗传隐私和歧视的立法法案的核心。对逆向选择的担忧有坚实的理论基础。这个项目的总体目标是确定如果BR CA 112测试信息可供希望获得但人寿保险公司无法获得的女性使用，那么这些理论上的问题是否可能在现实中发生。本项目的具体目标是：[a]开发一个基于计算机的精算模型，反映BRCA1/2测试对人寿保险合同成本的影响。[B]根据对个人行为的合理估计，制定这些结果的近似值。[c]根据对一群接受BRCA1/2测试的妇女的保险购买决定的观察，以及更具代表性的美国妇女样本的表达意向，完善这些估计。这项研究的结果将特别涉及可遗传乳腺癌和卵巢癌检测的精算含义，但更广泛地讲，也将涉及其他癌症和其他基因条件的预测测试。

The purpose of this project is to estimate the likely effects of testing for BRCA1 and BRCA2 mutations on the cost and price of life insurance contracts, under conditions where insurance companies do not have access to women's genetic test results.As opportunities increase for members of the public to undergo genetic tests that help predict future disease states, the insurance industry is becoming concerned that its financial solvency will be threatened unless it also has access to the same genetic information available to individuals. This threat comes in the form of "adverse selection." Those women who learn through genetic tests that they are at higher risk of death or disease may purchase more insurance. if insurers do not have access to the test results, they are less able to identify which individuals are at high risk and which are not, and so they cannot adjust premium prices appropriately. in theory, life insurance markets can disappear under such circumstances, leading to a situation in which no one can obtain insurance. Many insurance industry representatives point to the theory of adverse selection as a rationale for new regulations that might require that all genetic information available to individuals also be made available to the industry. This request for a "level playing field" contrasts with opposite efforts by consumer and patient groups to increase the privacy protection of genetic information-largely because of concerns that it will lead to discrimination of the very kind the insurance industry believes is essential for its solvency. Contemporary debates about this issue pit women's legitimate interests in privacy against insurers' legitimate interests in financial solvency. Very little empirical work is available to move these debates beyond rhetoric and anecdote, and yet they are the centerpiece of over a dozen recent legislative bills addressing genetic privacy and discrimination. The theoretical basis for concerns about adverse selection is sound. The overall goal of this project is to determine if those theoretical problems are likely to occur in reality if BR CA 112 test information is available to women who desire it, but remains out of the reach of life insurers. The specific aims of this project are: [A] To develop a computer-based actuarial model reflecting the impact of BRCA1/2 testing on the cost of life insurance contracts. [B] To develop approximations of these outcomes based on plausible estimates for individual behavior. [C] To refine those estimates based on observations of insurance purchasing decisions within a cohort of women tested for BRCA1/2 and the expressed intentions of a more broadly representative sample of US women. The results from this study will speak specifically to the actuarial implications of testing for heritable breast and ovarian cancer, but also more generally to other cancers and other genetic conditions for which predictive tests are developed.