Insurance practice inhibits GPs exploring the sexual behaviour of patientsBMJ 1996; 313 doi: http://dx.doi.org/10.1136/bmj.313.7067.1261d (Published 16 November 1996) Cite this as: BMJ 1996;313:1261
- Paul Thornton ()
- HIV/primary care facilitator Department of Public Health, Coventry Health Authority, Coventry CV1 2GQ
EDITOR,—P H Smee, the head of life insurance at the Association of British Insurers, states that incorrect evaluation of health risks by a life insurance company would be unfair to an applicant. But this is exactly what may have happened to many applicants who declared even a low risk of HIV infection in the past and were declined insurance. The interests of individuals with any risk of HIV infection are now perceived as best served by their not declaring that risk to the insurers and, by association, their general practitioner. The general practitioner can be bypassed by self referral to other health care services.
While demanding full information from prospective clients, the insurance companies keep their underwriting policies confidential. Potential clients cannot know in advance how a company would now react to the risk factors that they face. The problem is compounded by sharing of data on clients between competing companies. Patients cannot give informed consent to the release of information from their medical records.
Because 1% of clients are declined life insurance and 4% have loaded premiums,1 completion of reports to insurance companies is detrimental to the prevention, diagnosis, and treatment of disease in the individual patient. When the disease is infectious the underwriting process carries implications for the wider community. Insurance practice inhibits patients being open with their general practitioner about their sexual behaviour2; general practitioners exploring the sexual behaviour of patients where this may be clinically appropriate or an opportunity for preventive intervention exists; and two way communication between general practitioners and consultants in genitourinary medicine.3 Coincident infection with HIV and other sexually transmitted infections, particularly those that cause genital ulceration, has been cited as a major cause of increased transmissibility of HIV.
If only out of self interest, the insurance industry should consider the long term consequences of underwriting procedures on the important sexual health promotion activities that are possible in general practice.4 Now that we have better epidemiological evidence about the spread of HIV, the Association of British Insurers is in a position to re-evaluate its dogged adherence to pre-existing practice. In 1993–4 the Kensington, Chelsea and Westminster health district had 1186 HIV positive residents who consulted HIV services. Their general practitioners knew of the diagnosis in only 761 of these patients.5 If the British insurance industry still believes that it needs protection from HIV then it should recognise that the use of general practitioners at the underwriting stage is as helpful as a condom with a large hole in it.
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