Dread Disease Insurance towards local experience by rtu13707

VIEWS: 44 PAGES: 89

									                        Dread Disease Insurance
                        towards local experience

Wolfgang Droste
IAAHS - Colloquium 2004
29 April 2004




A Berkshire Hathaway Company
                               ?
A Berkshire Hathaway Company
Contents


1. Gen Re’s Survey
2. International Comparisons
3. Trends in Cancer Incidence
4. For Your Consideration




                                3
Contents


1. Gen Re’s Survey
2. International Comparisons
3. Trends in Cancer Incidence
4. For Your Consideration




                                4
Gen Re’s Survey


• Background information
• Claims analysis
  – Admitted claims
  – Cancer claims
  – Declinature
  – Incidence rates




                           5
Market Coverage

• Hong Kong (15), Malaysia (9) and Singapore (7)
• 4.0 million lives in force on 31.12.2000

                                     Singapore
                                        33%
                                                 Hong
                                                 Kong
                                                  22%



                              Malaysia
                                45%




Market Survey and Product Features                      6
                  In-force by sex

                   • Number of in-force policies issued to women > number of in-force
                     policies issued to men (for age 20 – 40)
                              90,000
Number of In-force Policies




                              80,000

                              70,000
                              60,000
                              50,000                                                        Male
                              40,000                                                        Female
                              30,000
                              20,000

                              10,000
                                  0
                                       0        10      20   30         40   50   60   70
                                                                  Age
                   Market Survey and Product Features                                              7
Average Sum Insured


• Average claim amount < Average sum insured

   As at 31/12/2000:
               $US                   Claims   In-force   Difference
   – Hong Kong:                      34,922    39,077    -10.5%
   – Malaysia:                       9,102      9,338    - 2.5%
   – Singapore:                      20,672    23,698    -12.8%




Market Survey and Product Features                                    8
Sales Volume


• No. of new policies à stable
   – Around 650,000 policies each year


• New business sum insured à increasing
   – US$12.5 billion (1996), US$14.5 billion (2000)


• Proportion of age 0 -19 policies (in-force) à increasing
   – 3% (1993), 17% (1998), 15% (2000)




Market Survey and Product Features                           9
Claims Analysis


• Background information
• Claims analysis
  – Admitted claims
  – Declinature
  – Cancer claims
  – Incidence rates




                           10
 Survey Basis

• 16,507 claims in total
• 13,832 Dread Disease claims (of which 87% admitted)
• 9,518 Admitted claims with cause of claim provided
Admitted claims (counted by number of policies):

                      Singapore
                         45%
                                                   Hong
                                                   Kong
                                                   23%



                                  Malaysia
                                    32%


                                                          11
Cause of Claim by Territory

                         Cause of Claim by Territory
100%
                                                         Others
90%

80%                                                      Total Permanent Disability

70%                                                      Other heart surgery excluding
                                                         Coronary Artery Bypass Surgery
60%
                                                         Coronary Artery Bypass Surgery
50%
                                                         Kidney Failure
40%

30%                                                      Stroke

20%
                                                         Heart Attack
10%
                                                         Cancer
  0%
            Hong Kong   Malaysia   Singapore   Overall

Cause of Claim                                                                        12
Cause of Claim by Duration

                       Breakdown by sex and duration

 Sex                             Male                    Female

 Duration                  0      1       2+      0        1       2+
 Number of Claims         727    720     2887    763      805     3616
 Cancer                  49.5%   53.6%   50.7%   81.8%   83.1%    84.9%
 Heart Attack            19.5%   19.3%   21.1%   1.6%    1.5%     1.8%
 Stroke                   7.6%   9.3%    9.0%    4.2%    3.4%     4.1%
 CABS                     4.3%   4.7%    4.4%    0.4%     0.4%    0.2%
 Kidney Failure           2.3%   3.2%    3.6%    3.0%    2.1%     2.2%
 Other heart surgery
                          2.8%   2.2%    2.1%    0.7%    0.5%     0.6%
 excluding CABS
 TPD                      1.8%   1.5%    1.4%    0.4%    0.2%     0.6%
 Others                  12.2%   6.1%    7.7%    8.0%    8.8%     5.5%




Cause of Claim                                                            13
The Most Common “Other” Causes of Claim

                               “Other” Claims
                         Hong Kong             Malaysia             Singapore
   “Other” claims
                             168                  217                  142
   (cause reported)
                      Benign brain tumor       Paralysis        Benign brain tumor
   1st place
                           14 (8%)             20 (9%)              25 (18%)
                                                                   Encephalitis
                          Paralysis        Benign brain tumor        10 (7%)
   2nd place
                          12 (7%)               19 (9%)               Coma
                                                                     10 (7%)
                                               Blindness
                            Coma                13 (5%)         Multiple Sclerosis
   3rd place
                           10 (6%)               Coma                 8 (6%)
                                                13 (5%)




Cause of Claim                                                                       14
Cause of Claim by Age – Males

Claims:          103    1781    2388    62
   100%

     90%                                      Others
     80%
                                              Total Permanent Disability
     70%
                                              Other heart surgery
     60%                                      excluding CABS
                                              Coronary Artery Bypass
     50%                                      Surgery (CABS)
                                              Kidney Failure
     40%

     30%                                      Stroke

     20%                                      Heart Attack

     10%                                      Cancer
      0%
                 0-19   20-39   40-59   60+

Cause of Claim                                                             15
Cause of Claim by Age – Females

Claims:          68     2297    2780    39
   100%
     90%
                                              Others

     80%                                      Total Permanent
                                              Disability
     70%                                      Other heart surgery
     60%                                      excluding CABS
                                              Coronary Artery Bypass
     50%                                      Surgery (CABS)
                                              Kidney Failure
     40%
     30%                                      Stroke

     20%                                      Heart Attack
     10%
                                              Cancer
       0%
                 0-19   20-39   40-59   60+


Cause of Claim                                                         16
Claims Analysis


• Background information
• Claims analysis
  – Admitted claims
  – Declinature
  – Cancer claims
  – Incidence rates




                           17
Declinature Rate

                     Declinature rate by calendar year
  25%


  20%
                                                         Hong Kong
  15%                                                    Malaysia

                                                         Singapore
  10%
                                                         Overall

     5%


     0%
              1996      1997    1998   1999    2000

Declinature                                                          18
 Declinature Rate

                    Declinature Rate by Sex and Territory

                                                        19%
   Male                                 11%
                                        11%
                                                              Hong Kong
                                                              Malaysia
                                                              Singapore
                                                      18%
Female                            9%
                                          12%



               0%         5%      10%           15%     20%



 Declinature                                                              19
Declinature Rate

              Declinature Rate by Cause of Declinature

                  Suicide

              Not Covered

      Definition Not Met

Within Waiting Period

          Non-disclosure

                   Others

                        0%   5%       10%      15%      20%       25%   30%

 * Only 11% of declined claims gave the reason for declinature.


Declinature                                                                   20
Declinature Rate

                     Declinature Rate by Cause of Claim
              Cancer


               Stroke


          Heart Attack

   Coronary Artery
   Bypass Surgery

      Kidney Failure


               Others


                     0%    5%    10%    15%    20%   25%   30%


Declinature                                                      21
Claims Analysis


• Background information
• Claims analysis
  – Admitted claims
  – Cancer claims
  –Incidence rates




                           22
Selection Effect: Insured Lives’ Cancer Rates


• Comparing survey results with population statistics on cancer
• Notes:
   – Population statistics may include more than one primary cancer site
   – No population data for Malaysia available
   – Source of population statistics:
       • Hong Kong Cancer Registry – New cancer cases in year 2000 (all sites
         excluding skin)
       • Singapore Cancer Registry Report No. 5 - Cancer Incidence in Singapore
         1993-1997 (all sites excluding skin)




Cancer Claims                                                                     23
 Selection Effect – Hong Kong

Crude Cancer Incidence rates - Male

                                                                                Insured
                   Insured lives (1996-2000)        Population (2000)
                                                                          lives/Population
                 No. of Claims    Cancer incidence Cancer incidence               Ratio
                   Duration           Duration     (all sites but skin)         Duration
Age                2+       All      2+       All                            2+          All
20-24               4        16    0.112    0.137          0.209            54%         65%
25-29              29        61    0.292    0.293          0.371            79%         79%
30-34              53        84    0.383    0.350          0.498            77%         70%
35-39             106      169     0.770    0.764          0.898            86%         85%
40-44             123      180     1.419    1.328          1.661            85%         80%
45-49              59        99    1.354    1.452          2.612            52%         56%
50-54              34        51    2.028    1.953          3.878            52%         50%
55-59              12        17    2.465    2.395          6.239            40%         38%



 Cancer Claims                                                                             24
 Selection Effect – Hong Kong

Crude Cancer Incidence rates - Female

                                                                                Insured
                   Insured lives (1996-2000)        Population (2000)
                                                                          lives/Population
                 No. of Claims    Cancer incidence Cancer incidence               Ratio
                   Duration           Duration     (all sites but skin)         Duration
 Age               2+       All      2+       All                            2+           All
 20-24             15        33    0.337    0.239          0.235          143%          102%
 25-29             53        82    0.423    0.339          0.417          102%           81%
 30-34            107      165     0.765    0.694          0.758          101%           92%
 35-39            169      248     1.465    1.282          1.373          107%           93%
 40-44            154      247     2.131     2.01          2.302            93%          87%
 45-49             93      156     2.274    2.215          3.237            70%          68%
 50-54             53        76    2.949    2.528          4.015            73%          63%
 55-59             29        38    5.107    4.517          5.073          101%           89%


 Cancer Claims                                                                                  25
Selection Effect – Singapore

Crude Cancer Incidence rates - Male

                No. of Claims    Cancer incidence Cancer incidence           Ratio
                  Duration           Duration     (all sites but skin)      Duration
Age              2+        All     2+        All                           2+       All
20-24              7        8    0.0924 0.0773            0.174           53%      44%
25-29             21       26    0.1878 0.1776            0.161          117%     110%
30-34             38       52    0.3126 0.3244            0.301          104%     108%
35-39             51       74    0.4121 0.4530            0.508           81%      89%
40-44             66       84    0.6740 0.6542            1.107           61%      59%
45-49             50       62    0.8407 0.8067            2.572           33%      31%
50-54             42       54    1.7463 1.8026            3.025           58%      60%
55-59             27       31    3.5905 3.2425            5.179           69%      63%


Cancer Claims                                                                             26
 Selection Effect – Singapore

Crude Cancer Incidence rates – Female

                                                                                Insured
                   Insured lives (1996-2000)        Population (2000)
                                                                          lives/Population
                 No. of Claims    Cancer incidence Cancer incidence               Ratio
                   Duration           Duration     (all sites but skin)         Duration
Age                2+       All     2+        All                            2+           All
20-24              10       20    0.1201 0.1709            0.221            54%          77%
25-29              49       55    0.3732 0.3158            0.249           150%         127%
30-34              78       97    0.5974 0.5529            0.576           104%          96%
35-39             155      203    1.2260 1.1868            1.061           116%         112%
40-44             221      272    2.1095 1.9324             1.98           107%          98%
45-49             243      294    3.5937 3.2787            4.398            82%          75%
50-54             129      155    4.1693 3.9236            3.979           105%          99%
55-59              58       70    5.1019 4.7975            4.885           104%          98%

 Cancer Claims                                                                              27
Site of Cancer (Insured Lives - Male)

                      Hong Kong, Malaysia & Singapore

                                                  Bone and connective tissue,
                                                  skin and breast
                10%             14%
                                                  Digestive organs and
                                      4%          peritoneum
12%                                               Genitourinary organs

                                                  Lip, oral cavity and pharynx

                                                  Lymphatic and
                                                  haematopoietic tissue
                                           27%    Other and unspecified

   25%                                            Respiratory and intrathoracic
                                                  organs
                           8%


Cancer Claims                                                                    28
Site of Cancer (Hong Kong Insured Lives - Male)

                           Hong Kong

                                            Bone and connective tissue,
                10%                         skin and breast
                           10%              Digestive organs and
      10%                        3%         peritoneum
                                            Genitourinary organs

                                            Lip, oral cavity and pharynx

                                            Lymphatic and
                                            haematopoietic tissue
                                      28%   Other and unspecified
32%
                                            Respiratory and intrathoracic
                                            organs
                      7%


Cancer Claims                                                              29
 Site of Cancer (Hong Kong Population - Male)

                 New Cancer Cases in Year 2000 (Age 20-49)

                                                   Bone and connective tissue,
                                                   skin and breast
                   5%          13%
           9%                                      Digestive organs and
                                      3%           peritoneum
                                                   Genitourinary organs

                                                   Lip, oral cavity and pharynx

                                                   Lymphatic and
                                                   haematopoietic tissue
29%                                                Other and unspecified
                                           34%
                                                   Respiratory and intrathoracic
                                                   organs
                    7%


 Cancer Claims                                                                    30
Site of Cancer (Insured Lives - Female)

                      Hong Kong, Malaysia & Singapore

                                                  Bone and connective tissue,
                            10%                   skin and breast
                     5%
                6%                  5%            Digestive organs and
                                                  peritoneum
                                                  Genitourinary organs
 18%
                                                  Lip, oral cavity and pharynx

                                                  Lymphatic and
                                                  haematopoietic tissue
                                                  Other and unspecified
                                         45%
          11%                                     Respiratory and intrathoracic
                                                  organs




Cancer Claims                                                                     31
Site of Cancer (HK Insured Lives - Female)

                          Hong Kong
                                       Bone and connective tissue,
                5%                     skin and breast
                     9%
         10%                4%         Digestive organs and
                                       peritoneum
                                       Genitourinary organs

                                       Lip, oral cavity and pharynx

18%                                    Lymphatic and
                                       haematopoietic tissue
                                       Other and unspecified
                                 42%
          12%                          Respiratory and intrathoracic
                                       organs



Cancer Claims                                                     32
Site of Cancer (Hong Kong Population - Female)

                  New Cancer Cases in Year 2000 (Age 20-49)
                                                    Bone and connective tissue,
                            9%                      skin and breast
                  6%
         9%                        6%               Digestive organs and
                                                    peritoneum
                                                    Genitourinary organs

                                                    Lip, oral cavity and pharynx

                                                    Lymphatic and
20%                                                 haematopoietic tissue
                                        38%         Other and unspecified

                12%                                 Respiratory and intrathoracic
                                                    organs



Cancer Claims                                                                  33
Female Breast Cancer Claims

            % of Female Cancer Claims due to Breast Cancer


 Hong Kong


    Malaysia


  Singapore


      Overall


                0%    10%      20%      30%     40%      50%




Cancer Claims                                                34
Female Breast Cancer Claims

                Age distribution of female breast cancer claims
      60-69

      50-59

      40-49
Age




      30-39

      20-29

      10-19

         0-9

                0%    10%      20%        30%        40%       50%    60%

                         Hong Kong   Malaysia   Singapore   Overall

Cancer Claims                                                               35
Female Cancer Claims

                          In-force duration of female claims

           Breast Cancer


    Classified* Cancers


                All Cancers


    All Dread Diseases


                              0%         20%              40%            60%        80%   100%

                                             duration 0      duration 1    duration 2+


       *This refers to cancer claims for which the sites are available

Cancer Claims                                                                                    36
Claims Analysis


• Background information
• Claims analysis
  – Declinatures
  – Admitted claims
  – Cancer claims
  – Incidence rates




                           37
Acceleration Type Dread Disease Policies

                                            Acceleration Type Benefit

                                            20,000 Death cover
                                        5,000 Dread Disease cover
                                                               Dread Disease


                                     Death               Payment of
                                                           5,000

                                                               Death


                                    Payment of           Payment of
                                      20,000               15,000

Incidence Rates & Actual/Expected Ratio Analysis                               38
Incidence Rates:
Death with Acceleration DD – Males

       Based on 2,301 actual claims
                     0.012


                     0.010

                                  +9.4% ? in comparison with last DD survey (1993-1997)
   Incidence Rates




                     0.008


                     0.006

                     0.004

                     0.002


                     0.000
                             20                 30                40               50                  60
                                                                 Age
                                      Crude rates 2003   Graduated rates 2003   Graduated rates 2000



Incidence Rates & Actual/Expected Ratio Analysis                                                            39
Incidence Rates:
Death with Acceleration DD – Females

       Based on 2,291 actual claims
                     0.010


                     0.008

                                  +17.9% ? in comparison with last DD survey (1993-1997)
   Incidence Rates




                     0.006


                     0.004


                     0.002


                     0.000
                             20                 30               40                50                  60
                                                                 Age
                                      Crude rates 2003   Graduated rates 2003   Graduated rates 2000



Incidence Rates & Actual/Expected Ratio Analysis                                                            40
Incidence Rates: Death with Acceleration DD

                                                  Death with Dread Disease Acceleration
                                    0.1000
      Incidence Rates (log scale)




                                    0.0100

                                                                                               Male
                                                                                               Female

                                    0.0010




                                    0.0001
                                             20      25   30   35   40    45   50   55    60
                                                                    Age

Incidence Rates & Actual/Expected Ratio Analysis                                                        41
Incidence Rates: Acceleration DD only

                                                   Dread Disease only (Acceleration type)
                                     0.1000
       Incidence Rates (log scale)




                                     0.0100

                                                                                                 Male
                                                                                                 Female

                                     0.0010




                                     0.0001
                                              20     25   30    35   40    45   50   55     60
                                                                     Age

Incidence Rates & Actual/Expected Ratio Analysis                                                          42
Initial Selection Effect by Territory

    Acceleration DD, age range 20 – 60, males

                        All territories

                       No of
                                  A/E
                       claims

 Duration 0             602      110%

 Duration 1             655       99%

 Duration 2+           2899      100%


*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

Initial Selection                                                         43
Initial Selection Effect by Territory

    Acceleration DD, age range 20 – 60, males

                        All territories   Hong Kong

                       No of
                                  A/E        A/E
                       claims

 Duration 0             602      110%       93%

 Duration 1             655       99%       91%

 Duration 2+           2899      100%       98%


*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

Initial Selection                                                         44
Initial Selection Effect by Territory

    Acceleration DD, age range 20 – 60, males

                        All territories   Hong Kong   Malaysia

                       No of
                                  A/E        A/E        A/E
                       claims

 Duration 0             602      110%       93%        135%

 Duration 1             655       99%       91%        102%

 Duration 2+           2899      100%       98%        103%


*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

Initial Selection                                                         45
Initial Selection Effect by Territory

    Acceleration DD, age range 20 – 60, males

                        All territories   Hong Kong   Malaysia   Singapore

                       No of
                                  A/E        A/E        A/E        A/E
                       claims

 Duration 0             602      110%       93%        135%        94%

 Duration 1             655       99%       91%        102%        103%

 Duration 2+           2899      100%       98%        103%        99%


*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

Initial Selection                                                            46
Initial Selection Effect by Territory

    Acceleration DD, age range 20 – 60, females

                        All territories

                       No of
                                  A/E
                       claims

 Duration 0             664       90%

 Duration 1             743       81%

 Duration 2+           3713      100%


*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

Initial Selection                                                         47
Initial Selection Effect by Territory

    Acceleration DD, age range 20 – 60, females

                        All territories   Hong Kong

                       No of
                                  A/E        A/E
                       claims

 Duration 0             664       90%       86%

 Duration 1             743       81%       85%

 Duration 2+           3713      100%       107%


*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

Initial Selection                                                         48
Initial Selection Effect by Territory

    Acceleration DD, age range 20 – 60, females

                        All territories   Hong Kong   Malaysia

                       No of
                                  A/E        A/E        A/E
                       claims

 Duration 0             664       90%       86%         96%

 Duration 1             743       81%       85%         71%

 Duration 2+           3713      100%       107%        82%


*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

Initial Selection                                                         49
Initial Selection Effect by Territory

    Acceleration DD, age range 20 – 60, females

                        All territories   Hong Kong   Malaysia   Singapore

                       No of
                                  A/E        A/E        A/E        A/E
                       claims

 Duration 0             664       90%       86%         96%        88%

 Duration 1             743       81%       85%         71%        92%

 Duration 2+           3713      100%       107%        82%        109%


*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

Initial Selection                                                            50
Initial Selection Effect

    Additional DD,

                        Male (age 25-60)     Female (age 25-55)

                       No of                  No of
                                    A/E                   A/E
                       claims                 claims

 Duration 0              60         80%         73        73%

 Duration 1              75         89%         91        80%

 Duration 2+             412       100%        600       100%


*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

Initial Selection                                                         51
Analysis by Smoking Status

                          Males                Females
                   No of                 No of
                                  A/E                A/E
                   claims                claims

 Acceleration DD

 • Smoker           625           142%    91        147%

 • Nonsmoker       1206           91%    2174        93%

 Additional DD

 • Smoker           109           140%    24        185%

 • Nonsmoker        224           94%     471       104%


Smoking                                                    52
Analysis by Smoking Status

          Smoker/non-smoker differential by age group
250%

200%

150%
                                                                  Male
                                                                  Female
100%

50%

  0%
          20-29   30-34   35-39   40-44   45-49   50-54   55-60

Smoking                                                               53
Analysis by Calendar Year – Males

                      A/E Ratios by Calendar Year

     120%

     110%

     100%

         90%

         80%

         70%
               1996        1997        1998       1999       2000

                  Hong Kong       Malaysia    Singapore   Overall



Trends                                                              54
Analysis by Calendar Year – Females

                      A/E Ratios by Calendar Year

     140%
     130%
     120%
     110%
     100%
         90%
         80%
         70%
         60%
               1996        1997        1998       1999       2000

                  Hong Kong       Malaysia    Singapore   Overall


Trends                                                              55
Contents


1. Gen Re’s Survey
2. International Comparisons
3. Trends in Cancer Incidence
4. For Your Consideration




                                56
International Comparisons

• Hong Kong, Malaysia and Singapore (HKMS)
     – Gen Re’s Survey (1996 - 2000)
• Taiwan
     – Life Insurance Association (1996-1999)
• UK
     – Report of the Healthcare Study Group (1991-1997)
• Australia
     – Gen Re Australia – Trauma Experience Analysis 1998-2000
• South Africa
     – Gen Re South Africa – Trauma experience Analysis, 1991-2002



International Comparison                                             57
Cause of Claim – Gen Re’s survey

                    Hong Kong, Malaysia and Singapore
 Sex                              Male                    Female

 Duration                  0       1       2+      0        1       2+
 Number of Claims         727     720     2887    763      805     3616
 Cancer                   49.5%   53.6%   50.7%   81.8%   83.1%    84.9%
 Heart Attack             19.5%   19.3%   21.1%   1.6%    1.5%     1.8%
 Stroke                   7.6%    9.3%    9.0%    4.2%    3.4%     4.1%
 CABS                     4.3%    4.7%    4.4%    0.4%     0.4%    0.2%
 Kidney Failure           2.3%    3.2%    3.6%    3.0%    2.1%     2.2%
 Other heart surgery
                          2.8%    2.2%    2.1%    0.7%    0.5%     0.6%
 excluding CABS
 TPD                      1.8%    1.5%    1.4%    0.4%    0.2%     0.6%
 Others                   12.2%   6.1%    7.7%    8.0%    8.8%     5.5%




Claims Experience                                                          58
 Cause of Claim - Taiwan

                                                    Taiwan
Sex                                        Male                                    Female
Year                    1996        1997    1998    1999    2000    1996    1997     1998    1999    2000
Number of
Claims                       921   1,398   2,013   2,539   3,396   1,187   1,637    2,325   2,881   3,731

Cancer                76.8%        78.0%   75.2%   72.9%   73.3%   89.0%   90.2%    88.5%   88.3%   88.1%

Heart Attack            7.3%       7.5%     8.6%   9.3%    9.1%    0.6%    0.4%      1.0%   1.1%    0.9%

Stroke                  4.1%       3.6%     5.0%   4.8%    5.4%    1.9%    1.5%      1.5%   1.6%    1.8%
Coronary
Artery Bypass           1.4%       1.8%     2.5%   2.4%    2.3%    0.3%    0.5%      0.5%   0.5%    0.4%

Kidney Failure          7.3%       7.4%     7.0%   8.1%    7.5%    7.2%    6.4%      7.6%   7.2%    7.8%
Major Organ
Transplant              1.3%       0.4%     0.3%   1.4%    0.4%    0.5%    0.4%      0.2%   0.6%    0.1%

Paralysis               1.8%       1.3%     1.3%   1.2%    2.2%    0.7%    0.7%      0.7%   0.9%    0.9%



 International Comparisons                                                                             59
   Cause of Claim - UK

                                               UK
 Sex                                   Male                         Female
 Duration                       0       1            2+      0        1         2+
 Cancer                        43.2%   49.3%        41.1%   79.7%   79.4%      74.4%
 Heart Attack                  34.6%   25.2%        31.2%    2.1%    2.7%       2.3%
 Stroke                         7.1%    9.8%         8.6%    6.2%    7.0%       6.5%
 Coronary Artery                6.6%    5.3%         7.1%    1.2%    0.0%       0.8%
    Bypass Graft
 Multiple Sclerosis             3.1%   3.3%         3.6%    6.1%     3.8%       8.6%
 Kidney Failure                 1.2%   1.6%         0.8%    1.6%     0.0%       0.5%
 Major Organ                    1.2%   0.0%         0.5%    0.5%     1.0%       0.0%
    Transplant
 PTD                            3.0%   5.5%         7.1%    2.6%     6.1%       6.9%

*** Claims from “other” causes made up about 2% of male and female DD claims



   International Comparisons                                                           60
 Cause of Claim - Australia

                                      Australia
Sex                                  Male                        Female
Duration                         0           1      2+       0            1      2+
Number of Claims                58          72     309      36        63        211
Cancer                       46.6%   44.4%       43.0%   69.4%    84.1%       82.0%
Heart Attack                 1.7%    26.4%       27.5%   2.8%      1.6%       3.3%
Stroke                       6.9%     4.2%       1.9%    11.1%     4.8%       4.7%
Coronary Artery
Bypass Graft                 6.9%     4.2%       7.8%    0.0%      0.0%       0.0%
Kidney Failure               0.0%     0.0%       0.3%    0.0%      0.0%       0.0%
Other                        37.9%   20.8%       19.4%   16.7%     9.5%       10.0%




 International Comparisons                                                       61
Cause of Claim – South Africa

                                  South Africa
               Sex                          Male   Female
               Number of claims              298     65
               Cancer                       29%     74%
               Heart Attack                 57%     12%
               Stroke                        7%     12%
               Other                         7%      2%




International Comparisons                                   62
Contents


1. Gen Re’s Survey
2. International Comparisons
3. Trends in Cancer Incidence
4. For Your Consideration




                                63
 Population Trends in Cancer - UK

                                   UK: crude rates (age 20+)

                   650
                   600
Rate per 100,000




                   550
                                                                        Male
                   500                                                  Female

                   450
                   400
                   350
                         1989 1990 1991 1992 1993 1994 1995 1996 1997


 Trends                                                                        64
Population Trends in Cancer - UK

                                 UK: male by site
   160

   140

   120                                                        Prostate
                                                              Lung
   100                                                        Colorectal


     80

     60
            1989 1990 1991 1992 1993 1994 1995 1996 1997

         *** Age standardised rates adjusted to 100 in 1989

Trends                                                                     65
Population Trends in Cancer - UK

                               UK: female by site
   120



   100                                                         Lung
                                                               Breast
                                                               Cervix
                                                               Colorectal
     80



     60
            1989 1990 1991 1992 1993 1994 1995 1996 1997

          *** Age standardised rates adjusted to 100 in 1989
Trends                                                                      66
Population Trends in Cancer – Hong Kong

                                     Hong Kong: crude rates
                    400
 Rate per 100,000




                    350

                                                                                        Male
                    300
                                                                                        Female

                    250


                    200
                          1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000




Trends                                                                                         67
Population Trends in Cancer – Hong Kong

                          Hong Kong: male by site
220
200
180
                                                              Prostate
160                                                           Rectum
140                                                           Nasopharynx
120                                                           Lung
100                                                           Stomach

 80
 60
     89

     90

     91

     92

     93

     94

     95

     96

     97

     98

     99

     00
   19

   19

   19

   19

   19

   19

   19

   19

   19

   19

   19

   20
         *** Age standardised rates adjusted to 100 in 1989

Trends                                                                   68
Population Trends in Cancer – Hong Kong

                           Hong Kong: female by site
 140


 120
                                                              Breast

 100                                                          Nasopharynx

                                                              Lung

   80                                                         Cervix


   60
      90
      91



      93
      94




      97




      00
      89




      92




      95

      96


      98

      99
    19
    19



    19
    19




    19




    20
    19




    19




    19

    19


    19

    19
         *** Age standardised rates adjusted to 100 in 1989

Trends                                                                      69
       Population Trends in Cancer – Hong Kong

                               Age standardised incidence rates

                   350
Rate per 100,000




                   300
                                                                                       Male

                   250                                                                 Female


                   200

                   150
                         1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000



       Trends                                                                                 70
Trends in Cancer – Hong Kong Insured Lives

                                  Age Adjusted Cancer Incidence Rate (Age20-60)
                            160
                            140
         Rate per 100,000




                            120
                            100
                             80
                             60
                             40
                             20
                              0
                                    1996      1997      1998      1999            2000
                                                 Male                    Female



Trends                                                                                   71
Trends in Heart Attack, Stroke & Heart Surgery

                                        Age Adjusted Incidence Rate
                                   Hong Kong Male Insured Lives (Age 20-60)
                            30

                            25
         Rate per 100,000




                            20

                            15
                            10

                             5

                             0
                                 1996      1997           1998         1999         2000
                                                  HA, Stroke, CABS, Heart Surgery



Trends                                                                                     72
Population mortality by cause of death – HK

                  Mortality per 100 000 -- Age 45-64
350
                                                                 Malignant
300                                                              neoplasms
                                                                 Heart diseases
250
                                                                 Injury and
200                                                              poisoning

150                                                              Cerebrovascular
                                                                 disease
100                                                              Pneumonia, all
                                                                 forms
 50                                                              All other causes

  0
         1971   1981   1991   1994   1995   1996   1999   2000

Trends                                                                              73
Population mortality by cause of death – HK

                   Mortality per 100 000 -- Age 15-44
50
                                                                 Malignant
45
                                                                 neoplasms
40                                                               Heart diseases
35
30                                                               Injury and
                                                                 poisoning
25
                                                                 Cerebrovascular
20                                                               disease
15                                                               Pneumonia, all
10                                                               forms

 5                                                               All other causes

 0
         1971   1981   1991   1994   1995   1996   1999   2000

Trends                                                                              74
Population Trends in Cancer - Taiwan

                                   Taiwan: crude rates

                   300
                   250
Rate per 100,000




                   200
                                                                   Male
                   150                                             Female
                   100
                    50
                    0
                         1991 1992 1993 1994 1995 1996 1997 1998


Trends                                                                    75
Population Trends in Cancer - Taiwan

                              Taiwan: age standardised rates

                   250
Rate per 100,000




                   200

                   150                                             Male

                                                                   Female
                   100

                   50

                    0
                         1991 1992 1993 1994 1995 1996 1997 1998


 Trends                                                                   76
Trends in Cancer – Taiwan Insured Lives

                                 Taiwan: crude rates

                   150
Rate per 100,000




                   100
                                                              Male
                                                              Female
                    50


                    0
                         1996   1997    1998    1999   2000


Trends                                                               77
 Trends in Cancer – Taiwan Insured Lives

                                Taiwan: age standardised rates

                   150
Rate per 100,000




                   100
                                                                        Male

                                                                        Female
                    50


                    0
                         1996       1997     1998    1999        2000


  Trends                                                                       78
 Trends in Heart Attack, Stroke & CABS

                               Taiwan insured lives: crude rates

                   25
Rate per 100,000




                   20

                   15                                                 Male

                                                                      Female
                   10

                   5

                   0
                        1996       1997      1998     1999     2000


  Trends                                                                     79
 Trends in Heart Attack, Stroke & CABS

                        Taiwan insured lives: age standardised rates

                   25
Rate per 100,000




                   20

                   15                                                  Male

                                                                       Female
                   10

                   5

                   0
                         1996     1997     1998     1999     2000


  Trends                                                                      80
Contents


1. Gen Re’s Survey
2. International Comparisons
3. Trends in Cancer Incidence
4. For Your Consideration




                                81
For Your Consideration


• Shape of rates
• Definitions




                         82
For Your Consideration

  Life-threatening Cancer
  Means the presence of one or more malignant tumours. The malignant tumour is to be
  characterised by the uncontrollable growth and spread of malignant cells and the invasion
  and destruction of normal tissue for which major interventionist treatment or surgery
  (excluding endoscopic procedures alone) is considered medically necessary.
  The following tumours are excluded:
• Tumours showing the malignant changes of carcinoma in situ (including cervical dysplasia
  CIN-1, CIN-2 and CIN-3) or which are histologically described as pre-malignant;
• All skin cancers including hyperkeratoses, basal cell carcinomas, squamous cell
  carcinomas and Melanomas of less than 1.5 mm maximum thickness as determined by
  histological examination using the Breslow method, unless there is evidence of metastasis;
• Non Life-threatening Cancers such as Prostatic cancers which are histologically described
  as TNM Classification T1 or are of another equivalent or lesser classification, Papillary
  Micro-Carcinoma of the Thyroid or Bladder and Chronic Lymphocytic Leukaemia less than
  Rai Stage 3.



                                                                                              83
For Your Consideration


• Shape of rates
• Definitions
• Medical advance & trends




                             84
For Your Consideration

Premium Rate Guarantee
                   No. of companies   % of in force policies
                 Guaranteed   Total        Guaranteed
  – Hong Kong:        2        15               6%
  – Malaysia:         8         9              85%
  – Singapore:        6         7              69%




Reviewability of definitions
  – None



                                                               85
For Your Consideration

Reviewability Clause

Your policy cannot be cancelled by us due to a deterioration in your health or
changes in your occupation or pastimes.

Your Dread Disease Plan provides financial assistance in the event that you suffer
a substantial loss as a result of one of the specified Dread Diseases defined in your
Policy Document. Due to the continuing advances in medical treatment and
diagnostic techniques, we may need to review the Definitions used in your Policy
Document to ensure that in the future they:

- remain appropriate with regard to medical terminology and classification,
- take into account effective cures and vaccines and modern diagnostic
procedures,

- include diseases considered appropriate in the future,

- exclude diseases which are found to have become minor.

We reserve the right, therefore, to adjust your Dread Disease Definitions and/or   86
premium.
For Your Consideration


• Shape of rates
• Definitions
• Medical advance & trends
• Effect on mortality studies




                                87
 For Your Consideration

          Death Claims cf. Mortality Tables


HKA01


                                                    Male
M83/88
                                                    Female



S88/93


     0%   10%      20%     30%      40%       50%

                                                           88
? Questions ?




                89

								
To top