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April 23, 2006 at 04:00 PM
Cardiovascular events, most notably heart attacks, are one of the main causes of critical illness insurance claims.
To deal effectively with this risk, CI underwriters inevitably take a conservative approach to all cases involving adverse cardiovascular (CV) risk factors.
The traditional approach to life insurance screening for cardiovascular disease has been embraced by CI underwriters. In some cases (blood pressure and blood sugar are good examples) this confers value. But then there also are screening modalities that not only have considerable baggage but that may also be overvalued when compared to more progressive alternatives.
To reduce excessive cost and minimize delays in CI underwriting the industry can take some positive steps right now. One is to rethink the basis for assessing overweight and obesity.
Today, the industry uses build (weight in relation to height). The problem with build is that it does not correlate very well with CV risk.
This risk is driven by the presence of abdominal obesity, which is distinct from peripheral obesity carried in the hips, thighs and buttocks. Abdominal obesity is linked to adverse lipid and glucose metabolism, both of which are powerfully associated with premature cardiac events. Peripheral obesity, on the other hand, is inert. Its only drawback is cosmetic.
By relying on build or its equivalent (and the same can be said of body mass index or BMI), the industry underprices many middle-aged males while at the same time overcharges older-age females. To remedy this inequity while also improving CI risk selection, the industry needs to turn to waist circumference (which could readily be measured on paramedical exams).
It is also time to question the value of the prevailing repertoire of CV tests.
How realistic is it to continue to use screening ECGs and stress tests when the priorities of insurance company senior management are (a) controlling business acquisition costs, (b) speeding up underwriting and (c) being more customer friendly?
