Genetics, Alzheimer’s disease, and long-term care insurance. (English) Zbl 1083.62537

Summary: This paper applies a model of Alzheimer’s disease (AD) developed by Macdonald and Pritchard (2000) to the question of the potential for adverse selection in long-term care (LTC) insurance introduced by the existence of DNA tests for variants of the ApoE gene, the e4 allele of which is known to predispose one to earlier onset of AD. It computes the expected present values (EPVs) of model LTC benefits with respect to AD for each of five ApoE genotypes, weighted average EPVs with and without adverse selection, and sample underwriting ratings. The paper concludes that adverse selection could increase costs significantly in a small LTC insurance market only if current population genetic risk is not much smaller than that observed in case-based studies, and if carriers of the e4 allele are very much more likely to buy LTC insurance. Finally, the paper considers the cost of a combined retirement package, providing both pension and LTC insurance, and shows that it can reduce adverse selection.


62P05 Applications of statistics to actuarial sciences and financial mathematics
62P10 Applications of statistics to biology and medical sciences; meta analysis
92D10 Genetics and epigenetics
Full Text: DOI


[1] Conte S. D., Elementary Numerical Analysis (1972) · Zbl 0257.65002
[2] Dullaway D., Long-Term Care Insurance: A Guide to Product Design and Pricing (1998)
[3] Farrer L. A., Journal of the American Medical Association 278 pp 1349– (1997)
[4] Humble R. A., British Actuarial Journal 4 pp 547– (1998)
[5] Jost B. C., Journal of the American Geriatrics Society 43 pp 1248– (1995)
[6] Macdonald A. S., Philosophical Transactions of the Royal Society 352 pp 1067– (1997)
[7] Macdonald A. S., North American Actuarial Journal 3 (1) pp 83– (1999) · Zbl 1082.62540
[8] Macdonald A. S., ASTIN Bulletin 30 pp 69– (2000)
[9] Manton K. G., Journal of Gerontology: Social Sciences 43 pp S153– (1988)
[10] Manton K. G., Journal of Gerontology: Social Sciences 48 pp S153– (1993)
[11] Norberg R., Insurance: Mathematics and Economics 17 pp 171– (1995) · Zbl 0836.62088
[12] Pritchard D. J., Life Assurance: Financial Implications of a Change in Insuring Behaviour Resulting from Individuals’ Increased Knowledge of Their Genetic Predispositions (1997)
[13] Warren V., Genetic Tests and Future Need for Long-Term Care in the UK: Report of a Work Group of the Continuing Care Conference Genetic Tests and Long-Term Care Study Group (1999)
[14] Watson R., On The Risk 14 (2) pp 57– (1998)
This reference list is based on information provided by the publisher or from digital mathematics libraries. Its items are heuristically matched to zbMATH identifiers and may contain data conversion errors. It attempts to reflect the references listed in the original paper as accurately as possible without claiming the completeness or perfect precision of the matching.