The ABI's latest draft of the critical illness cancer definition excludes some forms of prostate cancer. Kirstie Redford takes a look at how this may impact future cover and asks if it is time for a change?
With the Government's announcement to introduce population-based prostate screening in order to increase detection of prostate cancer before it becomes life threatening, critical illness (CI) providers have had to think quickly in case claims spiral out of control. The Association of British Insurers (ABI) Critical Illness Working Party did not stall in its reaction to the news and published a consultation paper in April this year, outlining possible solutions to the potential threat. After receiving the industry's views, the party now believes a change to the cancer definition is the best way forward.
This undoubtedly marks the beginning of further debates into the definition of cancers as a whole on CI plans ' and many questions need to be addressed. As disease detection techniques improve, will it be possible to provide comprehensive cover in the future? If more claims are turned down, will consumer confidence dampen in what is already a sluggish market? Or will the situation mirror the way HIV was handled by insurers in the 1980s, when term assurance rates increased by up to 100%, before declining when it was found that the risk had been misjudged?
Before any of these questions can be answered, it is important to understand the background of the issues in order to distinguish how developments in the medical world may relate to future provision of CI cover.
According to Department of Health statistics, prostate cancer currently kills about 8,500 men a year and around 19,000 men are diagnosed with the disease over the same period. The condition only affects men and is usually detected in later life, when it has often become life threatening and virtually untreatable. Prostate cancers that are detected early however, can be treated effectively and are often not life threatening.
A big investment
It is these alarming statistics that have prompted the Government to announce a 20-fold increase in funding for research into prostate cancer in order to develop new ways to detect the disease at an earlier stage. In April this year, health minister Lord Philip Hunt launched a two-year trial of treatments for prostate cancer, where 230,000 men, aged 50-69 will be screened through GP practices. In July this year, public health minister Yvette Cooper also announced a package of measures aimed at giving men better access to information about prostate cancer. Both of these initiatives aim to detect prostate cancer at an earlier age and stage of aggressiveness.
With both the determination of medical professionals to find more effective screenings and treatments and the backing of Government funding, insurers cannot afford to ignore the potential changes this is likely to bring.
The ABI Critical Illness Working Party has now published a revised definition of prostate cancer in an attempt to avoid potential premium hikes, while ensuring cover remains meaningful for consumers. The definition has not yet been finalised and is open to further consultation but has been modified in response to the majority views from groups both in and outside the industry.
Nick Kirwan, chairman of the ABI Critical Illness Party, says there is an overwhelming demand for a change in definition as premium increases could disadvantage both the industry and consumers. 'The biggest fear for many people in the industry is that CI cover will become unaffordable if premiums increase. We need to concentrate on making sure cover continues to meet the needs of consumers at an affordable price. Over 80% of respondents to the consultation paper felt that the definition should be changed as it would be in the best interest of consumers. It was felt that providers should continue to cover advanced forms of prostate cancer and insurers should be free to offer more cover by changing their premiums if they choose. There was also no material difference between the views of those in the industry and outside of the industry, such as consumer groups,' he says.
The revised definition takes into account the latest medical thinking, which suggests there are two types of prostate cancer. According to medical experts, although the tumours look similar from a distance, one type is more aggressive. The less aggressive the disease, the slower it emerges and so it is often not prominent until later in life. The more aggressive type of cancer is often found in younger men.
There are two different measures used to detect prostate cancer. The Gleason grading system measures how aggressive a cancer is and the Tumour, Nodes, Metastases (TNM) classification tool shows how advanced a cancer is and where it sits in relation to the prostate. The new definition aims to use both of these measures so that both the aggressive and more advanced but slower progressing forms of the disease are covered under CI plans.
The cancer definition, as it stands, covers all forms of prostate cancer. But the revised draft states that CI cover will only apply to tumours that are classified as having a Gleason score greater than six or having progressed to at least TNM classification T2. This means that non-life threatening cases would not be covered by CI policies unless insurers choose to include less serious cases for a presumably higher premium.
A false alarm?
However, whether this degree of action is actually necessary remains debatable, because as yet, there is no proof that the new screening initiative will lead to a dramatic increase in claims. According to Dr Chris Hiley, information manager at the Prostate Cancer Charity, just because men have access to screenings does not necessarily mean they will take advantage of them.
But on the flip side of the coin, Dr Hiley says it will probably be the men who have CI cover who are most likely to take the test. 'The number of detected cases of prostate cancer will undoubtedly go up. But it will be the minority of men who will actually pick up on this opportunity and pro-actively set out to have the test. However, it will probably be the same type of men ' those who are well informed about the risk of prostate cancer ' that would both welcome the screening and take out CI cover,' she says.
It is hard not to relate the situation to the HIV scare of the 1980s. But Kirwan believes that even if the first round of screenings are unsuccessful, more advanced techniques are being developed, so it is inevitable that insurers would have to modify cover in the near future. 'Even if the initial screenings are disappointing, it does not mean there will not be an even more effective test around the corner. Prostate cancer has been ignored for too long and now it seems that worldwide, people are determined to find new ways of detecting it,' he says.
According to Kirwan, population-wide screening in the USA has proved successful and if screening becomes more widespread in the UK, similar results are likely. CI providers also have to stay one step ahead of the game and anticipate increases so that new policies are not tied to a dated definition.
Tackling confusion
One problem that needs to be tackled with a change in definition is the possible confusion of consumers. The ABI is therefore prioritising the production of clear information, so consumers are fully aware of what will and what will not be covered by the policy. 'We are committed to looking at ways of how to make this information available,' says Kirwan.
Phil Cleverley, chief underwriter at GE Frankona Re, agrees that the only way the industry will be able to quash consumer fears is through education. But, as he says, this will be no simple task: 'There are fears that consumers will lose confidence in CI cover because of the proposed exclusions. But we do still want to cover serious cancers. The only way that we can make sure consumers do not lose confidence in CI cover is to make sure they understand why the exclusions are being made. The problem, however, is that it is a complex subject and it is hard to simplify the information.'
CI is designed to cover conditions of a life-threatening nature and it is for this reason that less serious prostate cancers will be exempt from policies. But without concise information explaining why the definition has narrowed, it is easy to foresee consumer confidence lagging. Insurers do provide cover for non-life-threatening conditions such as blindness, deafness or limb amputation. Although these conditions are severely life changing, who is to judge that being diagnosed with prostate cancer at an early stage will not have severe effects on patients psychologically if not physically? As screenings and treatments become more advanced, consumers may leap to the conclusion that it will only be a matter of time before other cancers will also become exempt of cover at preliminary stages.
Indeed, the ABI has already discussed the possibility of attaching the TNM classification exclusion to all cancers. This would make the cancer definition much easier to understand for consumers. But due to the slow nature of prostate cancer tumours, Kirwan says it would not be an appropriate cut-off point for other faster developing cancers. 'We have considered using the same exclusion for other types of cancer but we cannot justify them. Other cancers can be much more serious even though they have a similar classification,' he says.
Some serious questions undoubtedly need to be addressed before the latest draft of the cancer definition is finalised. The ABI is planning to have the final definition approved at the next review of the Statement of Best Practice in May 2002. The outcome of the definition may not only affect current cover for prostate cancer, but may lead the way for future CI cover as medical advances take place. This is an issue that will affect the whole industry. It is therefore vital that the whole industry make their views known. The time has come to decide.
Kirstie Redford is senior staff writer
