Shaheen Nicholas J, Dulai Gareth S, Ascher Brian, Mitchell Kate L, Schmitz Sarah M
Center for Esophageal Diseases and Swallowing, University of North Carolina Schools of Medicine and Public Health, Chapel Hill, North Carolina, USA.
Am J Gastroenterol. 2005 Mar;100(3):577-80. doi: 10.1111/j.1572-0241.2005.41422.x.
Barrett's esophagus (BE) is associated with an increased risk of adenocarcinoma of the esophagus. Despite this increased risk, most cohort studies demonstrate that the mean life expectancy of subjects with BE is no different than age-matched controls. The indirect costs associated with a diagnosis of BE are unclear.
To assess the effect of a diagnosis of BE on insurance premiums.
We assessed twenty national life insurance companies (10 in southern California, 10 in North Carolina) to determine the effect of a diagnosis of BE on life insurance premiums. Our base case in Los Angeles was a 36-yr-old female nonsmoker, and in North Carolina, a 43-yr-old Caucasian male nonsmoker, both in excellent health except for a diagnosis of prevalent BE with no dysplasia. The policy requested was a 20-yr guaranteed term life insurance in the amount of $1,000,000. Companies were asked for their best price exclusive of the BE, and also their best price when considering BE as a preexisting condition. For those companies not offering the "preferred" rates, the insurance representative was subsequently sent a physician's letter explaining BE and providing data substantiating a normal life expectancy in the condition. Companies were also asked for health insurance quotes, including premiums and deductibles, inclusive and exclusive of the diagnosis of BE.
Twenty national insurance companies were contacted. For the 43-yr-old man with no BE, the yearly "preferred" premium for life insurance averaged $1,255. The mean cost of the policies offered to the same individual with BE as a preexisting condition was $2,731 (p < 0.001). For the 36-yr-old female the base rate exclusive of BE was $517, with a range of $472-$551. After inclusion of the diagnosis of BE, the mean rate rose by 177%, to $1,434, with a range of $1,144-$1,896. Companies either refused to provide health insurance to the individual with BE or would not provide a quote without review of the medical record. None of the insurance companies changed their quoted rates after receiving the letter written by the physician on behalf of the individual.
Despite the preponderance of data demonstrating a normal life expectancy associated with the condition, a diagnosis of BE more than doubles life insurance premiums, and impacts the availability of health insurance. Further steps to educate insurance companies about the risks associated with BE are warranted, and patients should understand this additional "risk" of endoscopic screening for BE. There are significant indirect costs associated with a diagnosis of BE.
巴雷特食管（BE）与食管癌风险增加相关。尽管有这种风险增加，但大多数队列研究表明，BE患者的平均预期寿命与年龄匹配的对照组并无差异。与BE诊断相关的间接成本尚不清楚。
评估BE诊断对保险费的影响。
我们评估了20家全国性人寿保险公司（南加州10家，北卡罗来纳州10家），以确定BE诊断对人寿保险费的影响。我们在洛杉矶的基础案例是一名36岁不吸烟女性，在北卡罗来纳州是一名43岁非吸烟白人男性，除了患有无发育异常的BE外，两人健康状况均良好。所要求的保险政策是一份保额为100万美元的20年期保证定期人寿保险。我们询问各公司在不考虑BE的情况下的最优价格，以及将BE视为既有疾病时的最优价格。对于那些不提供“优惠”费率的公司，随后向保险代表发送了一封医生信件，解释BE并提供数据证明该疾病患者的预期寿命正常。我们还询问了各公司的健康保险报价，包括保费和免赔额，涵盖或不涵盖BE诊断情况。
联系了2０家全国性保险公司。对于43岁无BE的男性，人寿保险的年度“优惠”保费平均为1255美元。对于将BE视为既有疾病的同一男性，所提供保险政策的平均成本为2731美元（p<0.001）。对于36岁女性，不考虑BE时的基础费率为517美元，范围在472美元至551美元之间。纳入BE诊断后，平均费率上涨了177%，至1434美元，范围在1144美元至1896美元之间。各公司要么拒绝为患有BE的个人提供健康保险，要么在不查阅病历的情况下不提供报价。在收到医生代表个人撰写的信件后，没有一家保险公司改变其报价费率。
尽管大量数据表明该疾病患者的预期寿命正常，但BE诊断会使寿险保费增加一倍多，并影响健康保险的可获得性。有必要采取进一步措施让保险公司了解与BE相关的风险，患者也应了解BE内镜筛查的这种额外“风险”。BE诊断存在显著的间接成本。
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