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Health Insurance, Genetic Testing and Adverse Selection

Published online by Cambridge University Press:  10 May 2011

R. D. MacMinn ,
P. L. Brockett  and
J. A. Raeburn
R. D. MacMinn
Affiliation:
Edmondson-Miller Chair, Katie School, Illinois State University, Bloomington, IL 61790, U.S.A., Email: [email protected]
P. L. Brockett
Affiliation:
Gus Wortham Chair in Risk Management, Department of Information, Risk and Operations Management, McCombs School of Business, University of Texas, Austin, Texas 78712, U.S.A., Email: [email protected]
J. A. Raeburn
Affiliation:
Professor Emeritus of Genetics, University of Nottingham, Nottingham NG8 1BB, U.K., Email: [email protected]
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Abstract

The implications of genetic testing information availability for society, medicine, employment, and individual privacy rights have generated much political debate, legislation and academic research. Part of this debate centres on the ethical and economic considerations resultant from this expanded knowledge, particularly for insurance practices. Within insurance economics, the possibility of adverse selection has been debated and the potential for a ban on an insurer's use of genetic testing has been studied with respect to whether or not such a ban might actually result in insurance market failure due to this adverse selection. Studies have examined the issue using expected loss cost (actuarial or ‘fair’) pricing models, and have not considered either equilibrium (supply and demand) price setting as is present in markets, or the potentially swamping effect of background health care risks facing the insured, having nothing to do with any particular genetic mutation. Here we construct a supply and demand function with both high and low risk individuals in the presence of background health care cost risks, and derive an equilibrium price and market composition to determine whether, if genetic information is allowed for individuals, but this same information is not shared with insurers: (1) is market failure inevitable? (it is not if the background risk is sufficiently high relative to potential genetic risk costs); (2) will equilibrium prices result in all low risk insured exiting the market? (not in the presence of significant background risk); and (3) how much would prices increase and market sales decrease if insurers do not have the same genetic information as the insured? (prices will increase, but not necessarily very much in the presence of background risk, and not as much as that previously estimated in the insurance literature).

Keywords

Genetic TestingEquilibrium PricingBackground RiskAdverse Selection
Type
Papers
Information
Annals of Actuarial Science , Volume 2 , Issue 2 , September 2007 , pp. 327 - 347
Copyright
Copyright © Institute and Faculty of Actuaries 2007

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References

ABC (2007). DNA co-discoverer gets own genome sequenced. ABC News Online, June 2, 2007.Google Scholar
Akerlof, G.A. (1970). The market for ‘lemons': quality uncertainty and the market mechanism. Quarterly Journal of Economics, 89, 488–500.CrossRefGoogle Scholar
Armstrong, K., Weber, B., Fitzgerald, G.et al. (2003). Life insurance and breast cancer risk assessment: adverse selection, genetic testing decisions, and discrimination. American Journal of Medical Genetics Part A, 120A, 359–364.CrossRefGoogle ScholarPubMed
Arrow, K.J. (1963). Uncertainty and the welfare economics of medical care. American Economic Review, 53, 941–973.Google Scholar
Crocker, K.J. & Snow, A. (1992). The social value of hidden information in adverse selection economies. Journal of Public Economics, 48, 317–347.CrossRefGoogle Scholar
Dionne, G. & Doherty, N.A. (1992). Adverse selection in insurance markets: a selective survey. In (Dionne, G., ed.) Contributions to insurance economics. Boston, Kluwer Academic Publishers, 97–140.CrossRefGoogle Scholar
Doherty, N.A. & Posey, L.L. (1998). On the value of a checkup: adverse selection, moral hazard and the value of information. Journal of Risk and Insurance, 65, 189–211.CrossRefGoogle Scholar
Doherty, N.A. & Thistle, P.D. (1996). Adverse selection with endogenous information in insurance markets. Journal of Public Economics, 63, 83–102.CrossRefGoogle Scholar
Halek, M. & Eisenhauer, J.G. (2001). Demography of risk aversion. Journal of Risk and Insurance, 68, 1–24.CrossRefGoogle Scholar
Hirschhorn, J.N., Lohmueller, K., Byrne, E.et al. (2002). A comprehensive review of genetic association studies. Genetics in Medicine, 4, 45–61.CrossRefGoogle ScholarPubMed
Hoy, M. & Polborn, M. (2000). The value of genetic information in the life insurance market. Journal of Public Economics, 78, 235–252.CrossRefGoogle Scholar
Lander, E.S., Linton, L.M., Birren, B.et al. (2001). Initial sequencing and analysis of the human genome. Nature, 409, 860–921.Google ScholarPubMed
Lemaire, J., Subramanian, K., Armstrong, K.et al. (2000). Pricing term insurance in the presence of a family history of breast or ovarian cancer. North American Actuarial Journal, 4, 75–87.CrossRefGoogle Scholar
Macdonald, A.S. (1999). Modelling the impact of genetics on insurance. North American Actuarial Journal, 3, 83–105.CrossRefGoogle Scholar
MNT (2005). Restrictions on genetic testing and insurance extended to 2011, UK. Medical News Today, March 14, 2005.Google Scholar
NHGRI (1990). Understanding our genetic inheritance: the U.S. human genome project. The first five years FY1991–1995. National Human Genome Research Institute.Google Scholar
Ponder, B. (1997). Genetic testing for cancer risk. Science, 278, 1050–1054.CrossRefGoogle ScholarPubMed
Pratt, J.W. (1964). Risk aversion in the small and in the large. Econometrica, 32, 122–136.CrossRefGoogle Scholar
Struewing, J.P., Hartge, P., Wacholder, S.et al. (1997). The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews. New England Journal of Medicine, 336, 1401–1408.CrossRefGoogle ScholarPubMed
Subramanian, K., Lemaire, J., Hershey, J.C.et al. (1999). Estimating adverse selection costs from genetic testing for breast and ovarian cancer: the case of life insurance. Journal of Risk and Insurance, 66, 531–550.CrossRefGoogle Scholar
Venter, J.C., Adams, M.D., Myers, E.W.et al. (2001). The sequence of the human genome. Science, 291, 1304–1351.CrossRefGoogle ScholarPubMed
Ventura, L. & Eisenhauer, J.G. (2003). Survey measures of risk aversion and prudence. Applied Economics, 35, 1477–1484.Google Scholar