Harper P S
Institute of Medical Genetics, University of Wales College of Medicine, Cardiff, UK.
Philos Trans R Soc Lond B Biol Sci. 1997 Aug 29;352(1357):1063-6. doi: 10.1098/rstb.1997.0086.
Life insurance is a key element of the UK social structure in terms of family protection and house purchase; it thus needs to be viewed in this broad context, rather than solely as a commercial activity. Insurers have not so far actively requested genetic tests for life insurance, but have insisted on knowing of and being able to act on existing genetic test information. The main reason given for this has been to avoid serious adverse selection; however, this has never been adequately estimated. Review of the different major categories of Mendelian genetic disorders suggests that the scope for adverse selection is extremely limited and that insurers would lose little, and possibly gain more, by foregoing the disclosure and use of this information in relation to life insurance policies of 'normal' size and nature. The likely future use in service of genetic tests based on susceptibility or population screening makes it especially important that the issue is rapidly resolved for Mendelian disorders; so far there is no sign that insurers are willing to achieve this.
就家庭保障和购房而言，人寿保险是英国社会结构的关键要素；因此，需要从这一广泛背景来审视它，而不仅仅将其视为一种商业活动。到目前为止，保险公司尚未积极要求进行人寿保险基因检测，但坚持要了解现有基因检测信息并能够据此采取行动。给出的主要理由是避免严重的逆向选择；然而，对此从未进行过充分评估。对不同主要类别的孟德尔遗传病的审查表明，逆向选择的范围极其有限，而且对于“正常”规模和性质的人寿保险保单，保险公司放弃披露和使用这些信息所受损失很小，甚至可能获益更多。基于易感性或人群筛查的基因检测在未来服务中的可能用途使得迅速解决孟德尔遗传病问题尤为重要；到目前为止，没有迹象表明保险公司愿意做到这一点。
