보험업계(保險業界)의 과제(課題)

Future Medical Screening: A Challenge to the Insurance Industry

1) 생명보험(生命保險)에서의 Screening은 사정조건(査定條件)이며 충분(充分)한 기능(機能)을 갖인 기구(器具)이다. 2) Screening 기술(技術)은 의학적(醫學的)으로 충분(充分)히 명시(明示)되여 있으며 장래(將來)에도 일반적(一般的)인 임상적(臨床的)인 Rule에 따라야 한다. 3) Screening Parameter는 연령(年齡)이나 Risk-Group에 의(依)한 질병(疾病)의 Pattern에 따라야 한다. 4) Screening Parameter에서의 예후(豫後)의 추론(推論)은 임상의학적관찰(臨床醫學的觀察)과 Rule를 모두 고처(考處)하는 한(限)에서는 합법적(合法的)이다. 5) 민감(敏感)한 성격(性格)의 Screening 기술(技術)은 일관성(一貫性)있게 취급(取扱)하기 의(依)해서는 대단(大端)히 특별(特別)한 Rule를 필요(必要)로 한다. 6) HIV-항체시험(抗體試驗)과 같은 Screening-Parameter는 그들의 새로운 시험범위내(試驗範圍內)에서는 계속적(繼續的)인 과학적(科學的) Feedback를 필요(必要)로 한다. 7) 유전의학적시험(遺傳醫學的試驗은 생명보험(生命保險) Screening에서는 아직 사용(使用)하고 있지 않지만 생명보험의학(生命保險醫學)에서는 장래(將來)의 역할(役割)과 가능성(可能性)에 대(對)해서 검토(檢討)해야 될 것이다. 8) 보험업계(保險業界)의 Screening은 가능한(可能限) 역선택(逆選擇)을 배제(排除)하고 보험청약자(保險請約者)나 보험자(保險者)의 쌍방(雙方)에서 평균여명(平均餘命)을 짧게하는 어떠한 결함(缺陷)에도 같은 지식(知識)으로 대비(對備)해야 한다. 9) Screening에서의 Informed Consent, Counselling과 Confidentiality는 현재나 더욱 발전된 장래에서도 알맞게 취급하지 않으면 않된다.

After a short historical resume, screening is discussed on the basis of the current philosophy of Life insurance compaines in leading countries. This is followed by considerations with regard to the future in areas of major bearing on Life insurance screening which have emerged as important within the last decade. HIV-antibody testing is dealt with from the screening point of view followed by aspects regarding the applicability of tumour marker use in Life insurance medicine. Last but not least genetic testing will be addressed, taking into account prospects for the future, as well as the resulting responsibility in medical and underwriting terms. The major considerations and suggested guidelines can be summarized as follows: 1) Screening in Life insurance is a prerequisite for underwriting and is a well-functioning selection instrument. 2) Screening technologies are medically well defined and have to follow general clinical rules, also in the future. 3) Screening parameters should follow the patterns of diseases according to age and risk groups. 4) Screening parameters for prognostic use are legitimate as long as they are considered in conjuction with clinical medical observations and rules. 5) Screening technologies of a sensitive nature require very special rules for handling in the sense of "consequential ethies". 6) Screening parameters like HIV-antibody testing require ongoing scientific feedback in their new testing dimensions. 7) Screening in the form of genetic testing is as yet not used in Life insurance; its potential future role in Life insurfance medicine must, however, be discussed responsibly and in time. 8) Screening enables the insurance industry to rule out possible antiselection and provide for equal knowledge on the part of the insurance applicant and the insurer about impairements which shorten life expectancy. 9) Screening, informed consent, counselling and confidentiality must go hand in hand both now and to an even greater extent in the future.