When the benefit of perfect information is not clear-cut

At current pace of development in genome sequencing, it is conceivable that in the next decade or so, affordable technology will enable nearly everyone to learn about his/her susceptibility to certain diseases due to hereditary genes.  This is certainly a breakthrough in the medical field, where treatments can be tailored to individual’s genetic make-up.  It maximises the desired effect while minimising the side-effects.  But its impact on the industry of healthcare insurance would be less promising.

To keep premiums low, it is important to have risk-pooling at a large extent, which is the way Singapore is heading.  At the extreme there is UK’s National Health Service, where everyone is a compulsory participant.  I am not endorsing NHS in Singapore, as the cost of bureaucratic meddling could easily offset the intended benefit (low premium).

But the rationale for insurance is uncertainty and risk-pooling to begin with.  Each of us pays a small amount (or relatively small amount) in expectation that insurers will pay a big sum on the occurrence of an unlikely (or unwanted) event.  Knowledge in the link between genes and diseases greatly reduces the extent of imperfect information, and hence the extent of uncertainty, resulting in a smaller range of risk to pool - only those at the higher end.

People who have less to worry are willing to pay less in premiums, or not to buy at all.  Only those who have reason to expect a claim will buy, and are willing to pay more.  “Bad risk” people self-select into the customer pool, and premiums have to rise to accommodate higher frequency and severity of claims.  As such, “good risk” people face even less incentive to buy at higher premiums, where their money go to pay for others’ claims. Consequently premiums have to rise again and again, until the purpose of insurance is defeated. Adverse selection due to near perfect information leads to market failure in insurance, leaving customers worse off.

Whether to have genetic privacy law looks difficult.  The law is to avoid genetic discrimination by the insurers. If there is this law, we have insider information on our genes and our susceptibility to associated diseases, but our insurers don’t have. It can lead to market failure as described above. If there is no such law, insurance does not function well too. The cost can be prohibitively high for people with certain known risks, hitting those not well-to-do especially hard.

Such is the difficult impact of genome research on healthcare insurance.  As for now, I don’t favour a genetic privacy law, because the common practice of checking family history is equivalent to what genetic information is trying to reveal.

A more thorough analysis on the topic can be found in the latest issue of The Economist.

355 Responses to “When the benefit of perfect information is not clear-cut”

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  14. CrEsCeNt Says:

    you are quite complicated, but do you happen to know anything bout genetic manipulation? do singapore’s medical field ever discussed such a possibility? i mean it would be useless to detect a disease when it turns out that the disease cannot be prevented… however, genetic manipulation may well help a person from developing any uncurable or unpleasant genetic deformations…

  15. Arnold Says:

    To borrow your title, as I see it, genome sequencing is clearly genetic manipulation, as crEsCeNt, one of your commentators, mentioned.However lofty the purpose is, genetic manipulation echoes the exploits of the famed (or infamous ) Dr. Victor Frankenstein, a character in the novel written by Mary Shelley ” The Modern Prometheus”. Prometheus was the Titan who supposedly created mankind. Frankenstein was the mad scientist who created a “perfect creature”. Well we know how the story ended. Genetic manipulation can only be done at the ” creation level” and not during existence. It is not a cure but alteration or, to use a softer term, variation of genes, the basic unit of heredity.Science definitely bestowed upon man the power to change and modify the beings around him, himself included.
    This impacts not only the health care industry but the whole world as well.

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  67. jennybie Says:

    Whether to have genetic privacy law looks difficult. The law is to avoid genetic discrimination by the insurers. If there is this law, we have insider information on our genes and our susceptibility to associated diseases, but our insurers don’t have. It can lead to market failure as described above. If there is no such law, insurance does not function well too

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  90. MeEsh Says:

    This genome project, as I see it, uplifts human’s hope for longevity of well being by tracing possible human imperfections and finding ways to alter it for good. This may sound interesting and brilliant product of high-technology, but in the long run, we will see several diasadvantages accompanying this breakthough, including the above-stated concern by Yi Zheng.
    Today, the implementation of this project still considers a very small scope, for people still seeks to weigh between advantages and disadvantages.
    For me, no one can really tell to which of these outweighs because this is a very complicated web of issue, not only concerning science & technology but more importantly, the morality.
    This outbreak even more concerns me to where is this leading up to?
    I am just really confused why people keep on going beyond what is nature.
    there’s a lot of questions boggling my mind regarding this project, not only the insurance thing but more of the picture of the future generations.

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  105. wordsmith Says:

    humans what fuels them and their essence? wouldn’t you want to push the limits, go beyond the age with a certain wage ticket. we rely on God but we don’t defy Him. conducting these research might help a lot of people.

    technology & new found science made possible for these genetic imperfections to be altered. tailoring facial expression & body curves too? truthfully some of us can & can’t afford it. yet one day our children may live free from canceric cause & other health complications. as of that beauty parts & all that plastic surgery is something extra. hopefully humans would be more grateful of they have.

    for those unabled financial wise, therefore they go for insurance. it isn’t about taking benefits hoping for a big sum compensation later. It’s a necessity securing life’s uncertainty unless you have such mad figure in your bank account.

    the money that you throw premium or non monthly inside the whirlpool not just helps you but the people within. think & take it as donating while you’re preparing yourself for the worst.

    of course the people who provides these takes most of the cash pool but there’s always a hierarchy or system that you have to be in unless you make the system. the ties that binds us is not to be greed but give then feed. where we’re heading? I just hope we won’t go as far as human cloning but I heard now it’s already been conducted for military & espionage purposes.

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    good piece of writing….

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  183. l3in6 Says:

    Hello, world!

    I feel very optimistic about genome sequencing or genetic manipulation. After all, it is a branch of science and technology. Any research or technological breakthrough as history tells us all have a common goal and purpose: to enhance the quality of our lives.

    Genome sequencing is such a technology that I believe is very inevitable. In infancy stage though, it is just right to think that the possibilities are endless. It is but normal that while grasping the truth about those things comes several myths that brings fear to the whole world. Think for example when computer softwares and hardwares were still young. There was a fear about loss of many jobs among human, and remember the Y2K bug? We see that nothing bad really happened.

    I understand your fear about genome sequencing impact on the healthcare insurance system. Certainly, when this technology is ubiquitous some businesses would forgo. That is the truth about this constantly changing world. The computer and Internet again for example, its advent causes the phase out of fax machines, telegraph service, and electronic typewriters — industries that were once part of this world. But nowadays we see arising new industries like call centers, web programming and eCommerce-related.

    Another example is the automobile technology. Imagine yourself in the age of chariots and you’re hearing about the coming of engine-based vehicle. Of course you would fear about the downfall of certain businesses like manufacturers of chariot bodies or wheels. But automobile’s advent creates more industries like motors, petroleums, highway constructions, travel, fastfood chains, and motels.

    So why the fuss about genome sequencing or genetic manipulation? For as long as its mother is SCIENCE, isn’t it but wonderful or exciting to accept this breakthrough?

    I simply believe that science corroborates the will and words of God. It is just man’s self-interest coupled with cruelty that makes the world unfriendly. TECHNOLOGY IS JUST A TOOL in which any one may apply it positively or negatively. The core of the problem in fact is in the hearts of some people.

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  185. Joy Says:

    Genetic manipulation has long been practiced in plants. Look at genetically modified organisms, for all we know we are already eating some of this food. That’s probably the reason why there are new diseases now that are incurable, virulent new viruses which are resistant to drugs. Genetic manipulation whether in plants or humans, has its advantages and disadvantages, however, even as they modify the plants, it already causes new problem. For every gene that they manipulate there will always be an unknown effect that I am unsure whther we can handle it or not. As far as I know, there are more people now in the hospital than in the past. There are more new diseases and more people are sick than in the past. Research on predisposing factors on genetically susceptible diseases does not really guarantee that one will never get sick in the future. More diseases or sickness now are not genetically acquired but brought about by precipitating factors in our lifestyle. What we eat, drink, or breath. Genetics may predispose us at certain disease but not necessarily shield us from it. So insurance company need not worry much about it, I guess…:)

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  199. jiun yan Says:

    Yeah, i don’t this is the issue to worry about. i’m agreed with Joy. If u are screened to have certain cancer gene marker in your gene profile, it doesn’t meant u ‘ll have cancer in future.

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  205. arun Says:

    i work for a company that does sequencing and disease risk prediction for the common people :) . you should take a look at the GINA law passed by the US, it clearly states a person’s genome or any other DNA based information cannot be used by insurers or employers or anybody else to value a person. my bet is that most of the countries are gonna follow up on this and have their own versions of this law. so there isn’t much to worry about the insurers asking people to pay up coz of their genes. besides no body can say a guy is gonna get a heart attack for sure, it’s all probabilities that people get out of cheap genetic testing. if genome sequencing hits the markets(which will happen in less than 3 years), then people have to worry about their genetic data, privacy and issues like that

  206. christian Says:

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    add me on frendster,,,

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  212. Kikay Kit Says:

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  213. Rhizal Says:

    km mau jd tmn aku??????????????

  214. cathy Says:

    hi

  215. X非主流家族X乐乐 Says:

    hallo!

  216. cAesALLenE Says:

    hmmm h! guyz…i wAnt to meet more people….

  217. cAesALLenE Says:

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  218. Ryan Says:

    hello.hi.friend,how are you now?….and your family as well…nice meeting you here in this kind of pleasures…its my honor to be with you in be part of your millions of friend you had..i wish that we could able to communicate each other to family too…i wish we would know ourselves.im looking forward for this matter friend..again nice meeting you here again..more power!!!!godbless

  219. princess Says:

    add me plz…..

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  221. SuZie Says:

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    My life full of challenging,

  228. jonah Says:

    hi

  229. jonalene Says:

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  230. kiann Says:

    eow pow…….

  231. juvie Says:

    yah, its true…that is why we must know how to cope up and must know how to deal with the new advancements that this world has offered.

  232. arianna Says:

    HODBLESS US ALL

  233. arianna Says:

    GOD BLESS US ALL

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  235. Fernando Says:

    somewhere we belong is the culture of our individual manners..,.

  236. aida Says:

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  237. mae Says:

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  238. Rizky Says:

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  239. jarEd Says:

    danda

  240. rendell celna Says:

    music,,,,my life!!!

  241. ♥♠thErEzSaღ♥♠ Says:

    hellow

  242. ashley nicole Says:

    nice one…interesting since my course is related to that…genetics info…

  243. CHECKERD LOVE F Says:

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  245. tiffany Says:

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  249. aldibar Says:

    ….i really admire the writer,..

  250. kakai Says:

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  251. Mary Grace Says:

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  252. ELECTRO HELL" Says:

    resistance to arrogance

  253. reynaldo Says:

    itz amazing……..

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    ei pls add me.

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  255. ronnie Says:

    keep up the good work and then just relax every time you were in worried

  256. Arif Says:

    fany

  257. Arif Says:

    fanny

  258. 123 Says:

    naubos na nga po yung pictuer ko sa kaaaply eh!hindi po madali maka-aply,pero tama ka po kung minsan kasi ay pinangungunahan ko na agad na hindi matatangap,dahil sa medical.thanks sa advice!

  259. Ria Elaine Says:

    ahhh.

  260. Clarance Says:

    nice blog interesting creat more blog….. and keep up the good work

  261. Dothie Joy Says:

    hi,everyone!

  262. Roselyn Says:

    ala lang

  263. lastroute Says:

    HMMM=)

  264. muhammad Says:

    Al Qur’an adalah firman Allah yang di dalamnya terkandung banyak sekali sisi keajaiban yang membuktikan fakta ini. Salah satunya adalah fakta bahwa sejumlah kebenaran ilmiah yang hanya mampu kita ungkap dengan teknologi abad ke-20 ternyata telah dinyatakan Al Qur’an sekitar 1400 tahun lalu. Tetapi, Al Qur’an tentu saja bukanlah kitab ilmu pengetahuan. Namun, dalam sejumlah ayatnya terdapat banyak fakta ilmiah yang dinyatakan secara sangat akurat dan benar yang baru dapat ditemukan dengan teknologi abad ke-20. Fakta-fakta ini belum dapat diketahui di masa Al Qur’an diwahyukan, dan ini semakin membuktikan bahwa Al Qur’an adalah firman Allah.

    AL QUR’AN DAN ASTRONOMI
    Banyak fakta, seperti penciptaan alam semesta dari ketiadaan, mengembangnya alam semesta, serta garis-garis edar planet di jagat raya, yang hanya mampu diketahui melalui astronomi modern, telah diberitakan dalam Al Qur’an sekitar 1400 tahun lalu.

    AL QUR’AN DAN FISIKA
    Tahukah Anda bahwa unsur besi pada awalnya terbentuk di bintang-bintang di luar angkasa, bahwa materi diciptakan berpasang-pasangan, dan bahwa waktu adalah suatu konsep yang relatif? Al Qur’an telah mengisyaratkan tentang semua fakta ilmiah ini.
    AL QUR’AN DAN PLANET BUMI
    Banyak fakta ilmiah, dari lapisan-lapisan atmosfir hingga fungsi geologis gunung, dari proses pembentukan hujan hingga struktur dunia bawah laut, dijelaskan dalam ayat-ayat Al Qur’an.

    AL QUR’AN DAN BIOLOGI
    Al Qur’an memaparkan perkembangan embrio manusia dalam rahim ibu melalui penjelasan yang benar-benar sesuai dengan penemuan embriologi modern.
    INFORMASI MENGENAI PERISTIWA MASA DEPAN DALAM AL QUR’AN
    Allah mengisahkan dalam Al Qur’an tentang sejumlah peristiwa penting yang akan terjadi di masa depan, dan berbagai peristiwa ini terjadi persis sebagaimana kisah tersebut. PENGETAHUAN AL QUR’AN
    Untuk meningkatkan pengetahuan Anda tentang Al Qur’an, Anda dapat mengunjungi, “Pengetahuan Al Qur’an” dan “Indeks Al Qur’an”. Pada bagian ini, ayat-ayat Al Qur’an dikelompokkan menurut pokok bahasannya.

  265. don-carlo Says:

    gago kayong lahat

  266. addo Says:

    klah 2……………

  267. nita Says:

    ok deh!

  268. 1254mindoro st paco manila Says:

    hi jessa mitra 19 lovely

  269. 1254mindoro st paco manila Says:

    hi how are you i lovely

  270. iem Says:

    bissmillahirohmanirohim

  271. bobby-29a Says:

    very well said dude! kudos!

  272. khate Says:

    hi!!! i ask u??how 2 create the blogs??

  273. daud.s Says:

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  274. sapugerang Says:

    aku
    ikutan iach

  275. sapugerang Says:

    muhammad..

    gmana pendat mu tntang

    alquran dngan seni

  276. muffinheart Says:

    An acquaintance who works for WHO had his DNA taken as part of a project that is somewhat similar to this. It also aims to gather as much genetic information as possible for future generation’s reference. They tested his DNA in Texas and they found out that his DNA are similar to the DNA found in the burial site of Kublai khan.

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    http://muffinheart.blog.friendster.com/

  278. jolcen13bea Says:

    A HOMESICKNESS…Lonliness residing in this heart of mine For those giggles and laughters a far Yearning heart cannot be hidden with a veil of smile. Nor the other beautiful in the world can’t even be swept It seems nigthmare haunting over me …The vastness of the ocean,amezing,though it maybe Enormous sky, glorious as can be are just the soround that keep us I stay captive in this land. Dwelt by the shivering winter breeze….bright rays from approaching summer days assuring to thaw out this frozen aches as rosebush plying open each petal momentarily, I endeavor to wriggle out this captivity for I still have no more winter alone to stay.

  279. jolcen13bea says; Says:

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  280. ryckymalana Says:

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  281. Procopia Says:

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  283. julie hope Says:

    hellow…………

  284. Poria Says:

    People should read this.

  285. Ryan Kraizerzs-9 Says:

    Salam kenal aja

  286. ari Says:

    salam kenal buat teman-teman

  287. juita Says:

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  288. nani Says:

    anda menjadi terkenal dimana semua krn Tuhan itu baik

  289. Chayoe Says:

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  290. chrisforum Says:

    sounds good but futile, who cares???

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  292. ++Xexor++ Says:

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  295. zhuwail Says:

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  296. jopri_g Says:

    saya ingin dunia mengenal diri saya

  297. fauzan Says:

    saya ingin dunia mengenal diri saya

  298. fauzan Says:

    nice blogs..enteresting

    ajarin aku buat blog dong

  299. thanarrajj Says:

    hai this is thanarrajj from malaysia

  300. adie Says:

    it”s wonderful”s

  301. jawil85 Says:

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  306. joffreyloquez Says:

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  307. marycorvallecer Says:

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  310. DEXTER Says:

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  311. feezaleo Says:

    is taht your theory or what?

  312. muham Says:

    very good!!

  313. john Says:

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  314. john Says:

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  315. joffreyloquez Says:

    ……………a nightmare has yet to come…………..

  316. fathers Says:

    NICE ONE KEEP BLOGING MORE……..

  317. YHOKS Says:

    heheheehe

  318. YHOKS Says:

    I Love you All My friends

  319. mike_jardinel Says:

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  320. rhy Says:

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  321. kristofferabante Says:

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  322. juztine Says:

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  323. billie Says:

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  324. skandal Says:

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  327. skandal Says:

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  328. skandal Says:

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  329. daniela Says:

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  330. vanessa Says:

    whatever!

  331. far-east Says:

    music n video

  332. Rusdi Says:

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  333. ara Says:

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  334. mary patricia Says:

    The World As I See It

  335. bettergemy Says:

    that neat!

  336. joffreyloquez Says:

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  337. devi budiana Says:

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  338. junksfunk Says:

    Hmmm……it’s all cooooooooooooooollllllll….!!!!!!
    Actually, I didn’t even know what was just typed up there….
    Hhhhhh….
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  339. Nibong Says:

    Pergi mampus. Budak Biadab.
    Jahanam you.

  340. Nibong Says:

    Orang Malaysia, tapi tolong singapura.
    Pergi mampus. Budak Biadab.
    Jahanam you.
    Traitor !
    Pengkianap.

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  342. mishca Says:

    ,it is realy true but its not easy to do, as we observe now , most of our comunity are behind technoly,and most peaple working for there daily needs,how can they afford it,

  343. adijesco Says:

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  344. ann Says:

    …………………ithink you r very complicataed??????why?????

  345. fachria Says:

    sumpah aq benci bgt sam yg namax cinta, berulg kali dia nyakitin aq….
    bullshit z smuax, gak ad yg bsa buat snang, yg ad hanya air mata….

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  350. dionyabanes Says:

    nice topic but you did not notice the real problem…..

  351. Baka XiaoLuo Says:

    Pakero, Budak Bodoh.
    Don’t talk so much…but do nothing.
    Dig your own backside.
    Asshole, Nibong boi.

  352. seoptimizers Says:

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  353. joepet Says:

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  355. paliant Says:

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