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Modelling Adverse Selection in The Presence of a Common Genetic Disorder: the Breast Cancer Polygene

Published online by Cambridge University Press:  09 August 2013

Angus S. Macdonald  and
Kenneth R. McIvor
Angus S. Macdonald
Affiliation:
Department of Actuarial Mathematics and Statistics, and the Maxwell Institute for Mathematical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, U.K.Tel: +44(0)131-451-3209, Fax: +44(0)131-451-3249, E-mail: A.S.Macdonald@ma.hw.ac.uk
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Abstract

The cost of adverse selection in the life and critical illness (CI) insurance markets, brought about by restrictions on insurers' use of genetic test information, has been studied for a variety of rare single-gene disorders. Only now do we have a study of a common disorder (breast cancer) that accounts for the risk associated with multiple genes. Such a collection of genes is called a polygene. We take two approaches to modelling the severity of adverse selection which may result from insurers being unable to take account of tests for polygenes as well as major genes. First, we look at several genetic testing scenarios, with a corresponding range of possible insurance-buying behaviours, in a market model for CI insurance. Because a relatively large proportion of the population is exposed to adverse polygenic risk, the costs of adverse selection are potentially much greater than have been associated with rare single genes. Second, we use utility models to map out when adverse selection will appear, and which risk groups will cause it. Levels of risk aversion consistent with some empirical studies do not lead to significant adverse selection in our model, but lower levels of risk aversion could effectively eliminate the market.

Keywords

Adverse SelectionBRCA1BRCA2Breast CancerCritical Illness InsurancePolygene
Type
Research Article
Information
ASTIN Bulletin: The Journal of the IAA , Volume 39 , Issue 2 , November 2009 , pp. 373 - 402
Copyright
Copyright © International Actuarial Association 2009

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