The use of diagnostic and predictive genetic testing in life and health insurance underwriting practises continues to raise moral questions, but the current operating model wouldn’t allow for use of such data, said a panel of underwriting experts at this year's Association of British Insurers (ABI) conference.
Speaking as part of a panel that explored the use of predictive genetic testing as a "force for good" within the protection and health insurance space, panellists acknowledged there are a host of obstacles that would need to be addressed for both current insurance models and consumer understanding of genetic testing.
Nicky Bray, chief underwriter at Zurich, explained that the use of predictive genetic testing does align with industry interests in respect to "protecting families and customers against the risks regarding life expectancy or of ill health in the future."
Referencing the desire to avoid foreseeable harm, particularly in the context of the incoming Consumer Duty, Bray also acknowledged the possible impact on people who have received negative test results for conditions such as Huntingdon's Disease, cancer or cardiomyopathy.
"Even though they may be feeling well and healthy, all of a sudden the rug is pulled from under you them as to what's going to happen in the future," she said. "It's a very difficult area, but fundamentally we're all looking to protect the future of the customers and to avoid unnecessary, foreseeable harm."
Dr Keith Klintworth, managing director of VitalityHealth, said that most in the industry would support the benefits predictive testing would bring in terms of improving prevention and disease burdens, but that "none of that is going to manifest unless some certain parameters are addressed."
Pointing to how insurance providers use the information from testing as one such parameter, Klintworth also noted "components on the consumer side" that will come about due to an "asymmetry of information" and how the industry would react.
"The chances are, in my mind, it's going to discriminate against the consumer, because we are going to become ultra conservative," he commented. "As soon as we get hold of unknown risk in society, we tend to default to be a little bit more conservative."
Consumer concerns
Addressing the ethical implications of genetic testing, John Burke, chief medical officer and director of medical policy at AXA Health, said that the general public is "very switched on" to the prospects of genetic discrimination.
Explaining the viewpoint that genetic testing is often linked with the "spectre of being punished for inheriting something you didn't have a choice on," Burke noted that it is also linked to protected characteristics, such as race, which can have "pretty nasty unintended consequences if it's not handled correctly."
Ultimately, Burke said that for the time being, the ABI Code on Genetic Testing, which effectively bans insurers from asking consumers for the results of genetic tests, was a "necessary thing."
Picking up the thread of how consumers understand genetic testing, Gen Re's chief underwriter, Dave Nicholas, said public comprehension of the subject was variable but there are a number of resources available, such as Genetic Alliance UK, that provide support and advice.
"It's an extremely challenging area to understand, even for experts; whether diagnostic or predictive, it is often discussed in extremely challenging circumstances," he said. "For customers it's a difficult discussion at a difficult time."
Risk approach
When considering the prospect of anti-selection, Claire Nolan, head of L&H underwriting at Swiss Re, said that the foundation of the industry is in the pooling of risk where "we can be fair and equitable."
"The concern when we consider genetics is that when we're in environments where we either cannot ask for or don't use this information, then perhaps that balance becomes off, and we might see individuals choosing to either buy products they would not afford before or buy increasing amounts of these products," she explained.
Nolan noted that the fundamental point was to try to "predict human behaviour; something nobody's ever been very successful at," meaning the insurers would be largely hypothesising what consumers would do with results of genetic tests.
"I prefer that we're a little bit more open minded to those options. Yes, some people might choose to buy protection, but that's what we want, right? We want to protect families and individuals; we just want to do it in a manner that makes sure our products are sustainable," she commented.
Meanwhile, touching on the impact of how pricing would be impacted by genetic test results becoming available to insurers, VitalityHealth's Klintworth said that he believes pricing should move towards a more dynamic model that uses predictive information about consumers in conjunction with clinical data, family history and wellbeing factors.
"This is a whole new landscape that we aren't even considering at this time. One of the big advances this will need to come in for predictive genetics is the probability of success, because at the moment, there's some of [tests] which are really good, but others are a probability and they're a very low probability," he explained.
