LaSalle M D, Stock J A, Hanna M K
Division of Pediatric Urology, Children's Hospital of New Jersey, USA.
J Urol. 1997 Sep;158(3 Pt 2):1312-5. doi: 10.1097/00005392-199709000-00172.
We sought to determine life insurance underwriting practices for children diagnosed with multicystic dysplastic kidney or unilateral neonatal hydronephrosis, and evaluate whether management options (observation versus operative intervention) have an influence on such practices.
A questionnaire and history of 1 child with multicystic dysplastic kidney and 1 with unilateral neonatal hydronephrosis were distributed to 348 insurance companies licensed to issue life insurance policies in New Jersey. The medical director of each insurance company was requested to indicate the current underwriting practices for life insurance policies based on these 2 case scenarios, and asked whether observation or operative intervention influenced such decisions.
Of the 348 insurance companies licensed to issue life insurance 130 (37.4%) responded, including 5 (3.8%) that did not choose to participate in the study, 56 (43.1%) that did not issue life insurance to children and 69 (53.1%) that completed the questionnaire based on current life insurance underwriting practices. For a child with multicystic dysplastic kidney 10 companies (14.5%) would issue life insurance if treatment involved observation only, while 49 (71%) would do so after nephrectomy. For a child with unilateral neonatal hydronephrosis 19 (27.5%) companies would issue life insurance if treatment involved observation only, while 46 (66.7%) would do so after pyeloplasty.
Despite limited long-term data on and uncertainty about the natural course of multicystic dysplastic kidney and unilateral neonatal hydronephrosis, treatment options offered a child with a congenital urological anomaly may have a significant impact on the ability to obtain life insurance. Children with multicystic dysplastic kidney and unilateral neonatal hydronephrosis can usually obtain life insurance after early operative intervention (nephrectomy and pyeloplasty, respectively), although sometimes at higher cost.
我们试图确定针对被诊断为多囊性发育不良肾或单侧新生儿肾积水的儿童的人寿保险承保实践，并评估治疗选择（观察与手术干预）是否会对这些实践产生影响。
向新泽西州348家获得人寿保险政策发行许可的保险公司发放了1名多囊性发育不良肾患儿和1名单侧新生儿肾积水患儿的问卷及病史。要求每家保险公司的医学总监根据这两种病例情况指出当前人寿保险政策的承保实践，并询问观察或手术干预是否会影响此类决策。
在348家获得人寿保险发行许可的保险公司中，130家（37.4%）做出了回应，其中5家（3.8%）未选择参与研究，56家（43.1%）不向儿童发行人寿保险，69家（53.1%）根据当前人寿保险承保实践完成了问卷。对于多囊性发育不良肾患儿，如果仅采用观察治疗，10家公司（14.5%）会发行人寿保险，而在肾切除术后，49家（71%）会发行。对于单侧新生儿肾积水患儿，如果仅采用观察治疗，19家（27.5%）公司会发行人寿保险，而在肾盂成形术后，46家（66.7%）会发行。
尽管关于多囊性发育不良肾和单侧新生儿肾积水的自然病程的长期数据有限且存在不确定性，但为患有先天性泌尿系统异常的儿童提供的治疗选择可能会对获得人寿保险的能力产生重大影响。多囊性发育不良肾和单侧新生儿肾积水的儿童通常在早期手术干预（分别为肾切除术和肾盂成形术）后能够获得人寿保险，尽管有时费用较高。
