McEwen J E, McCarty K, Reilly P R
Division of Social Sciences, Ethics, and Law, Shriver Center for Mental Retardation, Inc., Waltham, MA.
Am J Hum Genet. 1993 Jul;53(1):33-45.
Rapid advances in our ability to test persons presymptomatically for genetic diseases have generated increasing concern that genetic information will be abused by insurance companies. Reasoning that the insurance companies may have the strongest interest in using genetic data and that the medical directors of those companies with responsibility for rating applicants would be a good source of information on the use of such data, we conducted a large survey of medical directors of North American life insurance companies. We received responses from 27 medical directors. Our results suggest that (1) few insurers perform genetic tests on applicants, but most are interested in accessing genetic test information about applicants that already exists; (2) the degree of insurers' interest in using genetic test results may depend on the face amount of the policy applied for and on the specificity and sensitivity of the test; (3) many companies employ underwriting guidelines with respect to certain genetic conditions but may not always have specific actuarial data in house to support their rating decisions; (4) a considerable degree of subjectivity is involved in most insurers' rating decisions; and (5) some of the medical directors who responded to our survey are not fully informed about certain basic principles of medical genetics.
我们对有遗传疾病症状前的人进行检测的能力取得了迅速进展，这引发了人们越来越多的担忧，即遗传信息会被保险公司滥用。考虑到保险公司可能对使用遗传数据最感兴趣，且那些负责评估申请人的公司的医学总监会是有关此类数据使用情况的良好信息来源，我们对北美寿险公司的医学总监进行了大规模调查。我们收到了27位医学总监的回复。我们的结果表明：（1）很少有保险公司对申请人进行基因检测，但大多数对获取已存在的关于申请人的基因检测信息感兴趣；（2）保险公司对使用基因检测结果的兴趣程度可能取决于所申请保单的保额以及检测的特异性和敏感性；（3）许多公司针对某些遗传状况制定了承保准则，但内部可能并不总是有具体的精算数据来支持其评级决策；（4）大多数保险公司的评级决策都涉及相当程度的主观性；（5）一些回复我们调查的医学总监并未充分了解医学遗传学的某些基本原则。
