Category: Morbidity

Group Term Life – Results of 2021 U.S. Market Survey

Mary Pat Campbell

Link: https://www.genre.com/knowledge/publications/2022/june/surveylhgtlsum2206-en

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Excerpt:

Gen Re is pleased to share the results from our latest U.S. Group Term Life Market Survey, an industry benchmarking survey covering the Group Term Life (GTL) and AD&D industry. The survey tracks sales and in‑force results as well as lapse rate and employee-paid data.

Twenty-one of the 29 companies participating in the 2021 survey have provided Group Term Life data over the past 10 survey years.

Twenty-nine companies provided GTL results for 2021. Twenty-seven provided AD&D results. On a combined basis, total GTL and AD&D in‑force premium reached $31.6 billion, with GTL representing the majority (94%) of the total. (Exhibit A)

For GTL in‑force premium, reported industry growth has ranged between 2% and 5% over the past 10 years. In 2021, in‑force premium grew by 6% compared to 2020.

After a five-year low of 1% growth in 2020, AD&D in‑force premium rose by 3% in 2021. (Exhibit B)

Author(s): Nicole Conti

Publication Date: 7 June 2022

Publication Site: Gen Re

Does Aging-In-Place Work? What We Don’t Know Can Hurt Us.

Mary Pat Campbell

Link: https://www.forbes.com/sites/ebauer/2022/06/05/does-aging-in-plahttps://www.forbes.com/sites/ebauer/2022/06/05/does-aging-in-place-work-what-we-dont-know-can-hurt-us/ce-work-what-we-dont-know-can-hurt-us/

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Excerpt:

In the book Aging in the Right Place from 2015, author Stephen Golant provides a number of reasons why that “right place” might be the longtime family home:

•The advantages of a familiar neighborhood: the individual knows the shops and services and can navigate the area well even after physical or cognitive decline.

•The advantages of a familiar home: spatial competence (finding your way when the power goes out, navigating steps out of familiarity)

•Preserving familiar relationships – friendships and service providers.

•The attachment to possessions and pets is not disrupted (e.g., vs. moving to no-pets home); the home not only contains memories of the past but also reminders of past successes.

•The home affirms one’s self-worth; one fears (whether rightly or wrongly) that others will consider the person a “retirement failure” upon moving.

….

“The bitter truth is that an older person can succeed at remaining in her or his own home and still live a life as empty and difficult as that experienced by nursing home residents. Feeling compelled to stay in one’s home, no matter what, can result in dwindling choices and mounting levels of loneliness, helplessness, and boredom.”

This is a stark message. But here’s an even more discouraging problem: in my research on the issue, I encountered one repeated refrain. There is no solid scholarly research which asks the question: “which choice is the better one, in terms of future quality of life, to stay or to move?” It’s not an easy question, to be sure: simply looking at the quality of life of the elderly and comparing those who live in single-family homes vs. various kinds of “elder-friendly” housing would not adequately distinguish between those who moved due to some sort of health problem and those who moved with the aim of preventing future health problems, for example.

Publication Date: 5 June 2022

Author(s): Elizabeth Bauer

Publication Site: Forbes

Non-COVID deaths are up a significant amount this year. What’s driving the increase?

Mary Pat Campbell

Link: https://www.abc.net.au/news/2022-08-08/non-covid-deaths-are-up-a-significant-amount-this-year/101309930

Excerpt:

There were an additional 4,000 non-COVID deaths, or a five per cent increase, in the first four months this year, compared with the pre-pandemic average.

The director of the Mortality Data Centre at the Australian Bureau of Statistics, Lauren Moran, said among the additional 4,000 deaths, more people died of chronic diseases compared to similar periods prior to the pandemic.

“We can see that for dementia, there’s been around a 20 per cent increase this year of the total number of deaths when we compare it to prior years, and around 18 per cent higher than expected for diabetes,” she said.

Ms Moran said that while some of the increase could be put down to natural variation and increases with an ageing population, the deaths are statistically significant and confirm a trend that began late last year.

Author(s): Annie Guest

Publication Date: 8 Aug 2022

Publication Site: Australian Broadcasting Commission News

Book Review: A Global History of the Black Death

Mary Pat Campbell

Link: https://undark.org/2022/07/29/book-review-a-global-history-of-the-black-death/

Excerpt:

James Belich’s new book, “The World the Plague Made: The Black Death and the Rise of Europe,” shows the depth and longevity of the controversy over the sources and impacts of an era-defining scourge. Belich, an Oxford University historian, suggests that what is now known as the Black Death was so consequential that its effects equal those of the Enlightenment, the Reformation, the Industrial Revolution, and the Renaissance. It’s a staggering implication, but he makes a decent case for it in this bold, tremendously researched work. From illustrating the plague’s effects globally to showing how central it was to Europe’s ascension, Belich demonstrates that the medieval pandemic influenced many aspects of human life.

Once called the Great Death or the Great Plague, the pandemic lasted hundreds of years and was so deadly that it is still popularly referred to simply as the Plague. “The Black Death Pandemic, beginning in 1345, persisted for more than three centuries and involved about 30 major epidemics in all,” writes Belich. What’s more, it “did not always behave like the modern pandemic,” he writes further on. “It killed far more people, for one thing.” Belich’s book implicitly underscores that, compared to the devastation of the plague, Covid-19 is relatively insignificant.

Just how many deaths was the Black Death responsible for? Despite centuries of debate on the subject, there is no consensus. The common belief is that the first wave killed between 25 percent and 33 percent of Western Europeans. (The historian Barbara Tuchman advanced the one-third estimate in her best-selling 1978 book about the 14th century, “A Distant Mirror.”) Belich suggests that the number was far higher. In the first strike alone, the population of Western Europe was cut in half, he writes, citing studies about the death rates in England, France, Italy, and Scandinavia. Many places didn’t return to their pre-plague population levels for some 250 years. (Despite his claims, the true extent of the toll is still widely contested.)

….

In Belich’s view, what made the plague different from other major historical events and catastrophes was that, while it decimated the human population, it left the material world untouched. It “doubled the average amount per person of everything,” from horses to housing, he writes. For a time, this meant more resources for survivors and greater access to luxury goods, better living conditions, and higher wages for workers.

Author(s): Jordan Michael Smith

Publication Date: 29 July 2022

Publication Site: unDark

Individual Disability Carriers Steer Through Uncertain Times

Mary Pat Campbell

Link: https://www.genre.com/knowledge/blog/2022/august/individual-disability-carriers-steer-through-uncertain-times-en

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Seventeen carriers participated in our 2021 U.S. Individual Disability Market Survey, representing 99% of the market and $5.1 billion of in‑force premium. New sales in 2021 were $399 million which was flat when compared to new sales in 2020. Breaking this down even further, both Non-Cancelable (Non‑Can) and Guaranteed Renewable (GR) sales were flat when compared to 2020. Non‑Can was down 0.1% and GR was up 0.5%. Of the $399 million in total new sales premium, Non‑Can products represent 84% or $334 million, and GR is 16% or $65 million.

When asked about meeting their 2021 sales goals, 47% of the responding companies said they missed theirs. 18% of the companies met and 35% of the companies exceeded their goals. Some of the reasons given for missing sales goals were:

COVID limited face-to-face contact with consumers

Agents were focused on other products such as life insurance

The number of new policies issued grew by 2% to over 251,000 and total benefit amounts increased by 3% to more than $1.6 billion. The medical market continues to be a main driver of new business. In 2021, close to 30% of all new policies sold were in the medical market; however, the industry did see some growth down-market with increases in the number of new policies sold in the blue collar space.

Author(s): Steve Woods

Publication Date: 3 Aug 2022

Publication Site: Gen Re Perspective

Think You’ve Never Had Covid-19? Think Again

Mary Pat Campbell

Link: https://www.wsj.com/articles/think-youve-never-had-covid-19-think-again-11658741403

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Dr. Ding is a member of a shrinking club of people who are pretty sure they have never been infected with SARS-CoV-2, the virus that causes Covid-19. Geneticists and immunologists are studying factors that might protect people from infection, and learning why some are predisposed to more severe Covid-19 disease.

For many, the explanation is likely that they have in fact been infected with the virus at some point without realizing it, said Susan Kline, professor of medicine at the University of Minnesota Medical School. About 40% of confirmed Covid-19 cases are asymptomatic, according to a meta-analysis published in December in the Journal of the American Medical Association.

More than two years into the pandemic, most people worldwide have likely been infected with the virus at least once, epidemiologists said. Some 58% of people in the U.S. had contracted Covid-19 through February, the Centers for Disease Control and Prevention has estimated. Since then, a persistent wave driven by offshoots of the infectious Omicron variant has kept daily known cases in the U.S. above 100,000 for weeks.

Yet some people haven’t gotten sick or tested positive.

Author(s): Julie Wernau

Publication Date: 25 Jul 2022

Publication Site: WSJ

Fentanyl Overdose Rates Are Rising Fast

Mary Pat Campbell

Link: https://www.wsj.com/articles/overdose-rates-are-rising-fast-cdc-drugs-opiod-crisis-substance-abuse-addiction-fatal-syringe-11652904604

Excerpt:

The latest tally of fatal drug overdoses from the Centers for Disease Control and Prevention shows nearly 108,000 fatalities in 2021. This is far more than in 2017, when President Trump declared drug deaths a public-health emergency. Among blacks, the drug mortality rate has quadrupled in less than eight years.

The Trump administration acted aggressively and directed agencies to implement several recommendations from the Commission on Combatting Drug Addiction and the Opioid Crisis. These included changes to prescribing patterns, treatment paradigms and law-enforcement procedures. The rate of deaths from drug overdoses slowed and then dipped. But then Covid hit, with all its mental-health consequences. The addiction and overdose crisis is now the most important public-health issue facing the country.

…..

Coincident with policy changes advertised as civil-rights progress, the comparatively low drug-overdose rate for blacks began to accelerate. It reached the white rate by 2019 and then surged past it during the pandemic to reach 43 annually per 100,000 of the black population by last September.

Rather than gawking at an accelerating overdose crisis, policy makers could benefit people of all races by investigating new sources of demand and supply. Instead, in a world where a single backpack of fentanyl could kill a million people, Mr. Biden eliminates the controls on illegal immigration instituted by his predecessor.

Author(s): Joseph Grogan and Casey B. Mulligan

Publication Date: 18 May 2022

Publication Site: WSJ

Racial Disparities in Maternal Health

Mary Pat Campbell

Link: https://www.usccr.gov/files/2021/09-15-Racial-Disparities-in-Maternal-Health.pdf

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Over the past two decades, the U.S. maternal mortality rate has not improved while maternal
mortality rates have decreased for other regions of the world. Furthermore, the rate at which
women in the U.S. experience short-term or long-term negative health consequences due to
unexpected outcomes of pregnancy or childbirth has also steadily increased over the past few
decades, with nearly 50,000 women in the U.S. experiencing these health consequences in 2014.
Significant racial and ethnic disparities persist in both the rate of women in the U.S. who die due
to complications of pregnancy or delivery and the rate that women experience negative health
consequences due to unexpected pregnancy or childbirth outcomes.

…..

Compared to any other racial or ethnic group,7 Black8 women experience the highest rates of
nearly all of Centers for Disease Control and Prevention’s (CDC) severe maternal morbidity9
indicators.10 Black women in the U.S. are 3 to 4 times more likely to die from pregnancy-related
complications than White11 women in the U.S., and Native American12 women are more than 2
times more likely to die from pregnancy-related complications than White women in the U.S.13
Pregnancy-related mortality is also slightly elevated for Asian women (a 1.1 disparity ratio),14
and for Hispanic women in some geographic areas.15 Moreover, the risk of pregnancy-related
death is so elevated for Black women in certain regions of the U.S. that it is comparable to the

rate of pregnancy-related deaths16 in some developing countries.17 This racial disparity has not
improved in decades,18 and is also seen in other middle to high-income countries with
multiethnic populations.19 According to the World Health Organization (WHO), the U.S.
maternal mortality ratio ranked 56th in the world in 2017.20 According to the National Center for
Health Statistics (NCHS), in 2018, the maternal mortality rate in the U.S. was 17.4 maternal
deaths per 100,000 live births, with 658 women dying of maternal causes.21 In 2019, the
maternal mortality rate in the U.S. was 20.1 maternal deaths per 100,000 live births, with 754
women dying of maternal causes.

Author(s): U.S. Commission on Civil Rights

Publication Date: September 2021

Publication Site: U.S. Commission on Civil Rights

Dissenting Statement and Rebuttal of Commissioner Gail L. Heriot in U.S. Commission on Civil Right Report: Racial Disparities on Maternal Health

Mary Pat Campbell

Link: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3924645

Full Citation:

Heriot, Gail L., Dissenting Statement and Rebuttal of Commissioner Gail L. Heriot in U.S. Commission on Civil Right Report: Racial Disparities on Maternal Health (September 15, 2021). San Diego Legal Studies Paper 21-028, Available at SSRN: https://ssrn.com/abstract=3924645 or http://dx.doi.org/10.2139/ssrn.3924645

Abstract:

On September 15, 2021, the U.S. Commission on Civil Rights published a report entitled Racial Disparities in Maternal Health (the “Report”). This Dissenting Statement and Rebuttal (the “Statement”) is a part of that report.

Among other things, the Statement points out several errors in Report. For example, the Report incorrectly states that maternal mortality has increased 50% over the last generation. What has actually happened is that changes in death certificates have caused more deaths to be classified as maternal in nature. The Report also emphasizes the theory that racism plays a prominent role in causing racial disparities in maternal mortality. The Statement points out in response that maternal mortality rates for Hispanic and Asian American mothers are lower than the rate for white mothers. This tends to detract from the theory that racism is what’s causing the disparities.

Author(s): Gail L. Heriot

Publication Date: 13 Oct 2021

Publication Site: SSRN

A Louisiana senator defends his statements on the state’s Black maternal health

Mary Pat Campbell

Link: https://www.nbcnews.com/news/nbcblk/cassidy-defends-statements-louisianas-black-maternal-health-statistics-rcna30166

Excerpt:

Black pregnant women continue to face disproportionately high pregnancy-related deaths, with data from the Centers for Disease Control and Prevention indicating a 26 percent increase in the maternal mortality rate for Black women since the start of the pandemic. 

Though researchers do not have an explanation for the disparities, the research suggests it’s a culmination of institutional racism and other health factors, such as the increased risk of obesity and hypertension in Black women. Howell also added that stress and a lack of access to quality prenatal care further exacerbates this issue. 

“It really does boil down to how public health officials relate to Black women who are giving birth,” Howell said. “Statistics about Black maternal mortality are high across the board, no matter what your educational level is, no matter what your insurance level is.” 

In 2018, tennis star Serena Williams opened up in an interview with Vogue magazine about encountering severe health complications after giving birth because doctors neglected to listen about her existing medical conditions.

“When you have someone like Serena Williams having problems giving birth, and not being treated properly by nurses and doctors when she complains about not feeling well, then you look at the doctor of someone who is poor in Louisiana, and has the same kind of problem — they are probably treated even worse,” Howell said.

Author(s): Tat Bellamy-Walker

Publication Date: 23 May 2022

Publication Site: NBC News

Accelerated Death Benefit Rider Financing Approaches

Mary Pat Campbell

Link: https://www.soa.org/sections/product-dev/product-dev-newsletter/2022/june/pm-2022-06-scholz-eaton/

Excerpt:

Living benefit riders to life insurance policies (also known as ‘combo’ or ‘hybrid’ policies) have become a core component of life insurance sales strategy. LIMRA reported that in 2020 “Combination products represented 24 percent of life insurance sales based on total premium.”[1] Concurrently, the long-term care insurance (LTCI) industry reached an inflection point when more LTCI (and chronic illness) benefits were sold through hybrid products than from standalone LTCI coverage.

On the spectrum of life and LTCI hybrid policies, the richest of these provide coverage of LTCI first through accelerating the policy’s death benefit, and then by providing extended LTCI benefits for many more years. There are a handful of individual and worksite insurers who sell these rich hybrid policies. On the other end of this spectrum are acceleration-only riders to life insurance policies. These riders provide policyholders the opportunity to receive a portion of the policy’s death benefit in advance, under certain conditions. Some of these riders do not cover qualified LTCI, but instead cover ‘chronic illness,’ which has a similar benefit trigger but is not formally LTCI.

This article outlines industry practice and consideration for pricing these acceleration-only policies. The National Association of Insurance Commissioners (NAIC) Model Regulation #620 addresses accelerated death benefit riders to life insurance policies.[2] Model Regulation #620 outlines three financing methods for accelerated death benefit riders which we describe in this article. The Interstate Insurance Product Regulation Commission (the IIPRC, or the “Compact”) adopted standards for some of these riders in the Additional Standards for Accelerated Death Benefits (IIPRC-L-08-LB-I-AD-3).[3] For companies filing chronic illness, critical illness, and terminal illness products in the Compact, these standards define—among other items—the form and actuarial submission requirements and benefit design options for accelerated death benefit riders. If a company is filing an acceleration rider for a qualified LTCI benefit, that product would be subject to the IIPRC individual LTC insurance standards.

Author(s): Stephanie Scholz and Robert Eaton

Publication Date: June 2022

Publication Site: Product Matters!, SOA

A Filmmaker Imagines a Japan Where the Elderly Volunteer to Die

Mary Pat Campbell

Link: https://www.nytimes.com/2022/06/17/world/asia/japan-plan75-hayakawa-chie.html?smid=url-share

Excerpt:

The premise for Chie Hayakawa’s film, “Plan 75,” is shocking: a government push to euthanize the elderly. In a rapidly aging society, some also wonder: Is the movie prescient?

TOKYO — The Japanese film director Chie Hayakawa was germinating the idea for a screenplay when she decided to test out her premise on elderly friends of her mother and other acquaintances. Her question: If the government sponsored a euthanasia program for people 75 and over, would you consent to it?

….

Close to one-third of the country’s population is 65 or older, and Japan has more centenarians per capita than any other nation. One out of five people over 65 in Japan live alone, and the country has the highest proportion of people suffering from dementia. With a rapidly declining population, the government faces potential pension shortfalls and questions about how the nation will care for its longest-living citizens.

….

Aging politicians dominate government, and the Japanese media emphasizes rosy stories about happily aging fashion gurus or retail accommodations for older customers. But for Ms. Hayakawa, it was not a stretch to imagine a world in which the oldest citizens would be cast aside in a bureaucratic process — a strain of thought she said could already be found in Japan.

Euthanasia is illegal in the country, but it occasionally arises in grisly criminal contexts. In 2016, a man killed 19 people in their sleep at a center for people with disabilities outside Tokyo, claiming that such people should be euthanized because they “have extreme difficulty living at home or being active in society.”

Author(s): Motoko Rich

Publication Date: 17 June 2022

Publication Site: NYT