How the DIY diagnosis will shape insurance

I recently stumbled on this site, which is crowdsourcing voices as part of a study to determine whether Parkinson’s disease can be detected by analysing phone-quality voice recordings. The research aims to build on recent studies that successfully demonstrated that the disease can be diagnosed by analysing speech recorded using high quality audio devices. The hope is to develop an app to test for Parkinson’s disease.

The rise of low cost diagnostic testing has the capacity to transform the insurance industry in a number of ways.

Genetic tests open up the opportunity for more individualised care. In 2013, Angelina Jolie publicly announced that she had undergone a prophylactic procedure to remove her breasts because she faced a heightened risk of breast cancer as a carrier of a defective BRCA gene (the gene produces proteins responsible for supressing tumours). In the coming months, screening of the defective gene rose by 37%. Three years later, New Zealand health insurer, Southern Cross, introduced an allowance to enable high risk members to seek prophylactic mastectomy treatment. Amongst the eligibility criteria is a positive genetic test confirming a defective BRCA gene.

Low cost testing also creates the opportunity for earlier diagnosis and treatment. In the case of some degenerative disorders, such as Parkinson’s Disease or Multiple Sclerosis, early symptoms are generally vague. Low cost testing provides an opportunity to screen patients for a broader range of conditions at an earlier stage, bringing forward diagnosis and treatment. Health funders, including the public sector, are generally reluctant to cover routine screening on the basis of cost-benefit. However, the value equation is changing as tests become more cost effective. Shameless promotion: Sovereign Private Health Plus provides a $500 health screening allowance (every three years after three years).

Finally, the availability of at-home diagnostic tests allow people to screen themselves in the privacy of their own home. We are familiar with at-home pregnancy tests but did you know that you can now screen yourself for HIV, Hepatitis, or elevated cholesterol? Whilst the democratisation of medical information is empowering, it does create disclosure risks for the insurer: information gained outside the traditional medical system may be undiscoverable to insurers, which increases the opportunity for anti-selection. The insurance system cannot function efficiently if customers avoid disclosing known risk factors.

As with any new technology, changes in diagnostic medicine bring both threats and opportunities. The challenge for insurers is to find a way to embrace these developments to enhance, rather than restrict, the customer value proposition.

Living with bowel cancer

Working in the insurance industry means that you get very comfortable talking about things that other people find quite confronting, things like dying, becoming disabled or developing cancer. One topic that a lot of people really don’t want to talk about is bowel cancer and I can understand why. It affects an area of the body that isn’t usually discussed in polite company and the on-going impacts on people’s lives aren’t for the squeamish.

But bowel cancer kills more people in New Zealand than breast and prostate cancer combined so it’s time we started talking about it. Given its bowel cancer awareness month I wanted to share my story as I live with its effects every day.

My partner developed bowel cancer in his twenties (he is now in his forties) which was successfully treated surgically with no need for chemotherapy or radiotherapy. I’d love to say this is where the story ends, but it doesn’t. Due to the nature of the surgery he had he has on-going effects every day and is also subjected to regular invasive surveillance procedures.

Because he had almost his entire large bowel removed he has to take medication every single time he eats. The medication is designed to slow down his digestive system so if he doesn’t take it an evening out ends pretty quickly. This means I have to keep a good supply in my handbag just in case he forgets his pills. On the other hand though, if he takes too many pills he can get a painful bowel blockage.

We’ve also had to go to the hospital in the middle of the night a few times when he has suffered bowel obstructions brought on by the scar tissue surrounding his intestines and remaining large bowel. Thankfully he has never needed surgery to correct this but I’m scared that one day he will.

Because he developed bowel cancer at a very young age and his father died of it in his fifties, he needs to have regular monitoring. This means every two years he has a colonoscopy, every four years a gastroscopy and at times when his on-going pain has gotten really bad, MRIs to see if there is anything else going on. Every time he goes in for these checks I worry that this will be the time it comes back, or that his specialist will miss something or he’ll suffer some complication associated with the procedure.

So while my partner is cancer free, we will never really be free of bowel cancer.