Genetic discrimination and life insurance: a systematic review of the evidence

Yann Joly,Ida Ngueng Feze,Jacques Simard

doi:10.1186/1741-7015-11-25

Abstract

BackgroundSince the late 1980s, genetic discrimination has remained one of the major concerns associated with genetic research and clinical genetics. Europe has adopted a plethora of laws and policies, both at the regional and national levels, to prevent insurers from having access to genetic information for underwriting. Legislators from the United States and the United Kingdom have also felt compelled to adopt protective measures specifically addressing genetics and insurance. But does the available evidence really confirm the popular apprehension about genetic discrimination and the subsequent genetic exceptionalism?MethodsThis paper presents the results of a systematic, critical review of over 20 years of genetic discrimination studies in the context of life insurance.ResultsThe available data clearly document the existence of individual cases of genetic discrimination. The significance of this initial finding is, however, greatly diminished by four observations. First, the methodology used in most of the studies is not sufficiently robust to clearly establish either the prevalence or the impact of discriminatory practices. Second, the current body of evidence was mostly developed around a small number of 'classic' genetic conditions. Third, the heterogeneity and small scope of most of the studies prevents formal statistical analysis of the aggregate results. Fourth, the small number of reported genetic discrimination cases in some studies could indicate that these incidents took place due to occasional errors, rather than the voluntary or planned choice, of the insurers.ConclusionImportant methodological limitations and inconsistencies among the studies considered make it extremely difficult, at the moment, to justify policy action taken on the basis of evidence alone. Nonetheless, other empirical and theoretical factors have emerged (for example, the prevalence and impact of the fear of genetic discrimination among patients and research participants, the (un)importance of genetic information for the commercial viability of the private life insurance industry, and the need to develop more equitable schemes of access to life insurance) that should be considered along with the available evidence of genetic discrimination for a more holistic view of the debate.

Highlights

Since the late 1980s, genetic discrimination has remained one of the major concerns associated with genetic research and clinical genetics
In the United Kingdom, the Association of British Insurers and the British government have agreed on a Concordat and Moratorium on Genetics and Insurance that significantly restricts the capacity of British insurers to request genetic information from insurance applicants [8]
To assess the state of the evidence, we looked for all studies published in the scientific literature documenting the occurrence of genetic discrimination (GD) in the context of life insurance

Summary

Introduction

Since the late 1980s, genetic discrimination has remained one of the major concerns associated with genetic research and clinical genetics. Legislators from the United States and the United Kingdom have felt compelled to adopt protective measures addressing genetics and insurance. Among the fields of potential discrimination, one of the most commonly-debated topics has been the use of genetic information by the insurance industry to select applicants and determine insurance premiums. In the United States, the much-discussed Genetic Information Nondiscrimination Act of 2008 (GINA) (2008) offers protection mainly in the domains of health insurance and employment [7]. In the United Kingdom, the Association of British Insurers and the British government have agreed on a Concordat and Moratorium on Genetics and Insurance that significantly restricts the capacity of British insurers to request genetic information from insurance applicants [8]. Australian (2008 amendment to the Disability Discrimination Act), Canadian and East Asian policymakers have been active in this area, less so than their European counterparts [6,9]

Methods

Results

Conclusion