When the applicant knows more than the underwriter there is always a heightened risk of antiselection. In the past people didn’t know much about their health and wellbeing, but their physician did, which is why the APS has been such a valuable underwriting tool, such a reliable source of medical information.
For as long as it is available the APS should continue its role in the underwriter’s defensive armory, but increasingly it is no longer the sole source of historical medical information about the applicant. Thanks to technology, applicants are getting to know a lot more about themselves. Consider the following:
- The Nike+ Fuelband (US$180 approx) is a motion monitor. Worn on the wrist, it measures everyday activity, tracking steps taken, stairs climbed, etc, and the calories burned in the process, enabling the wearer to check progress against activity goals. It connects to a PC via a USB cable and wirelessly to a smartphone via Bluetooth. The Fuelband also tells the time.
- Jawbone UP (US$170 approx) is another motion monitor, also worn on the wrist, and has the same sort of functionality and connectivity as the Nike+ Fuelband. But it also tracks sleep (light v deep sleep and waking moments) and mood, and its alarm function will wake you from a power nap after the “optimal” time (“around 26.5 minutes”). It also has an ‘insight engine’ that allows you to “discover connections and patterns in your day-to-day activities.”
- Withings produces a range of smart health-related products. Its Pulse device (US$95 approx) enables you to track activity, sleep and heart rate. Its Blood Pressure Monitor (US$125 approx) does what it says, and measures your heart rate too. You wrap the monitor band around your arm and hook it up to your iPhone or other Apple device, and get an instant read-out or an average over time. The results are saved automatically. Withings’ Smart Body Analyzer (US$150 approx) is a set of smart scales that weighs you, calculates your BMI (you have to measure height yourself though), estimates your fat-lean ratio, measures your pulse rate through your feet and measures ‘air quality’ (temperature and carbon dioxide – in case you can’t figure out yourself it’s getting stuffy). You can access your stored data via dedicated web and mobile apps (iOS/Apple and Android).
- Fitbit’s Flex is an activity and sleep tracker with a wireless connection to your chosen device(s). One is like Flex but isn’t a wristband. Zip tracks your steps, distance and calories burned, and syncs those to your computer or smartphone. Aria is another ‘smart scale’. (Go on Amazon to get a feel of the pricing for all these.) See where we’re going with this? But there’s more:
- Mole Detective and SkinVision are smartphone apps that use the device’s camera to evaluate moles for melanoma risk (although these and similar apps have been criticized for unreliability).
- With the AliveCor app you can do your own ECG on your iPhone.
- The SpiroSmart app turns an iPhone into a spirometer by applying an algorithm to the audio input at the device’s microphone to calculate air volume.
- The uChek urine analyzer uses the iPhone’s camera to interpret reagent dip-strips to detect leukocytes, ketones, urobilinogen, bilirubin, protein, glucose and blood, and to calculate specific gravity and pH. The results can be stored on the phone, uploaded to another device or emailed.
- uHear is an app for Apple devices that detects hearing loss.
Less hi-tech are apps that enable patients to monitor their condition and log data for later discussion with their physicians, for example diabetics logging blood glucose and other data (but the smarter physicians and healthcare providers will enable that data to be sent wirelessly to their own systems, auto-updating their records and even triggering review visits if an ‘alert’ situation arises). Even less hi-tech, home HIV tests are available for around US$40, and you (or rather one) can test for sexually transmitted infections at home without having to trouble your physician or a clinic.
All this is available now. It is the medical evidence of the future. How are you going to get it? How are you going to use it? How are you going to verify that it is your applicant’s information? Will there be additional anti-selection?
How close is the future? It could be as close as you want it to be.