While we underwriters do not get directly involved in the sales process for the most part, there are likely some advantages to accrue to us if we suggest some “angles,” if you will, that help our producers make the value of CI policy ownership clear to prospective customers.
This is one approach that I think has merit, especially in the USA.
A friend from abroad said to me a few years ago that critical illness insurance would not be much of a seller in the US market.
In a word: baloney!
CI has an irresistible impact in America, in some ways because of how it compensates for medical care concerns highly prevalent in this country.
In the last few years, there has been an accelerating incidence of papers in the medical literature that make disconcerting distinctions between outcomes of therapies (indeed, I have found two more brand new articles on this sensitive subject since I wrote this article) – most notably the more risky surgical procedures – in hospitals which do high volumes of that procedure as compared to hospitals where that intervention is performed markedly less often.
To me, these reports are nothing short of eye-opening!
They also have profound implications for the informed consumer’s decision to purchase CI.
Most Americans with private health insurance have access their coverage by virtue of their employment. In many (most?) cases, there are limitations governing the choice of doctor and/or hospital. By inference, these restrictions would frequently preclude participants from choosing the highest volume – for that procedure – hospital in their community, etc.
Therefore, if one wanted the best level of care, with the lowest probability of complications or death, one might well have to have disposable funds at hand to provide for that care out of pocket.
In a 2005 study published in one of America’s most prominent medical journals, patients having coronary bypass surgery in a low volume hospital had more than twice the risk of dying during hospitalization than those who had their CABG done in a high volume surgical facility.
In another study, those with newly-discovered breast cancer were three times as likely to be under-treated in a low volume institution because those hospitals tended not to do an adequate lymph node assessment and thus miss evidence of silent cancer metastasis.
In a third study, 30 days mortality was inverse to hospital volume (in other words, the higher the volume, the lower one's risk of dying) for the same procedure, as well as most other major procedures.
“Initiatives to facilitate referral of patients to HVHs
[high-volume hospitals] have the potential to
reduce overall hospital mortality in the
state of California…”R. Adams Dudley, MD, MBA
University of California, San Francisco
Journal of the American Medical Association
283,9(March 1, 2000):1159-66
Compelling findings, aren’t they?
This issue also extends to physician experience in treating major impairments.
A report from “Wild Rose Country” (the Province of Alberta) showed that in-hospital deaths of patients handled by low volume doctors – where the treatment in question was concerned – was 40% higher when a patient was attended by high volume MDs.
Does the quality of therapy also differ on the basis of hospital volume?
You bet.
A major cardiology paper detailed how there was a 3-to-10-fold difference in the proportion of patients treated with the best-choice medications based on whether one was seen in a high volume, as compared to a low volume, medical center. This also extended to deployment of ideal diagnostic testing and surgical interventions.
The take-home message here should be loud and clear: if you want to enjoy the flexibility of maximizing your chances of surviving a critical illness, you want to make sure you are treated at a high volume hospital!
And you probably cannot do that unless you have critical illness coverage.
A related issue underscores the importance of acquiring CI coverage from a quality-of-care perspective.
Most of the latest and most effective drugs becoming available to treat – and sometimes cure – malignancies as well as other catastrophic conditions covered under typical CI policies are exquisitely expensive. Monoclonal antibody drugs, for example, often cost 10 to 50 times more than conventional alternatives used for the same condition (but less effectively).
Ongoing research assures that this phenomenon will only accelerate. More and more expensive drugs that will tax the capacity of the health insurance providers are in the pipeline. In fact, at least one or two seem to appear every month now and that’s just in the USA!
Many persons who have had a heart attack or stroke will be motivated to pursue taking various classes of cardiovascular drugs even if their situation does not satisfy their insurer’s criteria for availing themselves of such medications (in the context of their health plan). They will want these drugs to marginally lessen their risk of further events…even where that risk is judged to no worse than average in the context of their history and prevailing clinical guidelines.
Are already-strapped health carriers going to support the extravagant costs of such additive therapies?
If not, will the CI benefit paid out for the heart attack or stroke be the salvation of the middle-income policy owner who would be greatly encumbered if he had to fund this own optimal secondary prevention?
These are hard realities of 21st century medicine.
They are also provocative arguments for securing CI coverage as a key part of one’s insurance portfolio.