Transcript Canadian Institute of Actuaries L’Institut canadien des

2009 General Meeting
Assemblée générale 2009
Canadian
Institute
of
Actuaries
L’Institut
canadien
des
actuaires
2009 General Meeting ● Assemblée générale 2009
Ottawa, Ontario ● Ottawa (Ontario)
2009 General Meeting
Assemblée générale 2009
CRITICAL ILLNESS INCIDENCE STUDY UPDATE
(PD-15)
Charlie Philbrook
Emile Elefteriadis
CIA General Meeting
19 November 2009,
Agenda
2009 General Meeting
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Introduction – Emile Elefteriadis
Incidence Rate Development OverviewCharlie Philbrook
Incidence Rate Development ExampleEmile Elefteriadis
Experience Study-Charlie Philbrook
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Introduction
• Living Benefits Subcommittee formed in late 2006
• Initial mandate to focus on Critical Illness (CI) and
develop a base table and experience study.
– two reports; one for the table and its development and
one for the experience study
– to assist the profession
– a rich source of population based data to derive
incidence rates
– display various methodologies of construction
– it will be a table showing population adjusted incidence
– collect and compare experience to a reference table
• Similar to Staple Inn reports on CI
• Report on table to be published before Q2 2010
Introduction
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• Current committee members
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Alethea Lyn
Anke Roman
Banasha Shah
Charlie Philbrook
Chris Piper
Debra Shelley
Dominic Hains
Frederic Jacques
Geoff MacDonell
Graham Dixon
Ian Jack
Martin Vezina
• Former members: Cathy Shum-Adams, Saul Gercowsky
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Purpose and Scope of the Study
To develop a base table from Canadian data
which can be used for benchmarking experience
and determining appropriate pricing and valuation
bases.
•There is differentiation by age and sex but not by
smoking status.
•There is no adjustment for insured selection and
underwriting impact (other than prevalence and
first-ever adjustments).
•It’s a population based table.
Illnesses Covered
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Cancer (Life-threatening, Benign Brain Tumour, Malignant
Melanoma, Early Stage Prostate, Ductal Carcinoma in situ
Heart (Heart Attack (AMI), Coronary Artery Bypass Graft (CABG),
Coronary Angioplasty, Heart Valve Surgery, Aortic Surgery
Stroke
Kidney Failure
Major Organ Failure/Transplant
Multiple Sclerosis
Alzheimer’s Disease
Parkinson’s Disease
Loss of Independent Existence
Minor Conditions (Coma, Occupational HIV, Blindness &
Deafness, Paralysis, Severe Burns, Loss of
Limbs/Dismemberment, Loss of Speech, Bacterial Meningitis,
ALS-Motor Neuron)
Data Sources
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Most sources cover the general population in
Canada.
Major Sources
• Canadian Institute for Health Information (CIHI)
• Statistics Canada (StatsCan)
• Canadian Cancer Statistics, 2007.
• Institute for Clinical and Evaluative Studies
(ICES)
Development of Incidence Rates
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Definition
Base source
Trending
First-ever adjustment
Sudden death adjustment
Overlap
Prevalence
31-day mortality
Summary
General Process
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Identify the insurance definition for condition
Find applicable data useful for calculating incidence
rates
Make adjustments to the data to reflect definition,
gender and age, first occurrence, prevalence, etc.
Document the assumptions and process
Present to sub-group with peer review and once
final present to entire group
CI Definition of Multiple Sclerosis
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Benchmark Definition:
Thanks to
Chris Piper
for this
section!
Multiple Sclerosis is defined as “a definite diagnosis
of at least one of the following:
– two or more separate clinical attacks, confirmed by
magnetic resonance imaging (MRI) of the nervous system,
showing multiple lesions of demyelination; or,
– well-defined neurological abnormalities lasting more than
6 months, confirmed by MRI imaging of the nervous
system, showing multiple lesions of demyelination; or,
– a single attack, confirmed by repeated MRI imaging of the
nervous system, which shows multiple lesions of
demyelination which have developed at intervals at least
one month apart.
The diagnosis of Multiple Sclerosis must be made by
a Specialist.”
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Possible MS Data Sources
Canadian MS Sources:
– MS Society of Canada
– Study on incidence and prevalence of MS
in Saskatoon.
– Alberta study using Alberta Health Care
Insurance Plan data
International MS Sources:
– European sources – Finland has high
rate of MS similar to Canada
– Staple Inn Report (Exploring the Critical
Path)
Saskatoon Study
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Why use Saskatoon study data?
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Canadian source with best level of detail
– age and gender splits
Need to decide whether good
representative data for all of Canada
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Saskatoon Study Incidence
Rates
Incidence of multiple sclerosis in Saskatoon, 1970 to 2004
Age
Men
Women
Total
Rate*
Rate*
Rate*
0-14
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0.3
0.15
15-24
4.1
18.3
11.5
25-34
11.5
25.9
18.7
35-44
8.5
20.0
14.5
45-54
5.9
7.7
6.8
55-64
1.6
4.8
3.2
65-74
1.1
0.4
0.7
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4.7
11.2
8.1
75
Total
•Incidence rate per 100,000 Saskatoon population, 2001.
Source: Incidence and Prevalence of Multiple Sclerosis in Saskatoon, Saskatchewan
Population Mix Adjustment
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Are there significant differences in the
characteristics of the population in
Saskatoon relative to Canada in general
which could impact the incidence rates?
MS incidence and prevalence has been
shown to vary based on:
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Ethnicity
Country / Region – higher in Canada and within
specific regions in Canada (prairies)
Gender – higher in females (F:M – 2.1 to 3.6
depending on study)
Overall incidence adjusted to Canadian population
is 102.8% for Male and 102.4% for Female
Progressive Form Adjustment
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The insurance definition of MS pays
out on a more progressive form of the
condition – not initial diagnosis.
This means that a method is needed
to adjust the data to reflect when the
payment would occur under the CI
definition. Sources:
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Staple Inn Paper
Kurtze Expanded Disability Status Scale
MS Society
Progressive Form Adjustment
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Without further data the Modified
Staple Inn approach is preferred
approach:
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Simple approach
Approach: 10% occur immediately with
90% occurring evenly over the next 14
years.
Trending Adjustment
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Nothing conclusive to suggest an
increase in incidence in the population
since 2001. There was evidence of
increases in the 50 years prior but
could be due to advancements in
medical technology and ability to
diagnose.
Recurrence Adjustment
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Not relevant for MS as it is a
progressive condition with symptoms
that change over decades of the
diagnosed person’s lifespan.
Overlap Adjustment
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The overlap adjustment is important
for other conditions such as Stroke,
Coronary Artery Bypass Surgery, etc.
as there exists a strong correlation in
the incidence of the conditions.
No overlap adjustment was assumed
for MS as there is no available
evidence linking MS to any of the other
critical illness conditions in the study.
Prevalence Adjustment
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Same source as incidence rates –
essentially zero adjustment by age
and gender.
Estimates are that 55,000 to 75,000
cases exist in Canada.
30 Day Survival Adjustment
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General population mortality as initial
mortality rate not known to increase
significantly.
More important for conditions such as
heart attack and stroke.
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Final Incidence Rates
2008 Canadian MS Incidence Rates per 1000
Male
Female
Age
Initial Rate With Adjustments Initial Rate
With Adjustments
20
0.042
0.015
0.187
0.065
30
0.118
0.069
0.265
0.208
40
0.087
0.102
0.205
0.237
50
0.061
0.079
0.079
0.161
60
0.016
0.046
0.049
0.076
70
0.011
0.017
0.004
0.034
75
0.010
0.016
Comparison to Other Sources
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2008 Canadian MS Incidence Rates per 1000
0.3000
0.2500
0.2000
0.1500
0.1000
0.0500
0.0000
15
25
Male
35
45
Female
55
Male SI
65
75
85
Female SI
Source: Staple Inn Report (Exploring the Critical Path)
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Canadian Individual Critical
Illness Morbidity Study
• Purpose is to study CI experience relative to the
reference tables and report results along
dimensions that are of interest to actuaries
• Similar to individual mortality report, but tailored to
Critical Illness
»
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by covered condition
by ROP vs non-ROP
by # of covered conditions
results presented in pivot table format
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Canadian Individual Critical
Illness Morbidity Study
• Basis of Investigation
– Canadian adult lives, individual, single life only
– fully underwritten (nonmed, paramed, medical)
– standard and substandard
– stand-alone and acceleration
– conversions and plan changes (original age and
duration)
• First study will cover claims and exposures for policies with
policy anniversary years ending in 2003 – 2007
• 6 insurers have agreed to participate so far (with a 7th
committed for next year) and a few others are still deciding
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Canadian Individual Critical
Illness Morbidity Study
• Study contracted to Barbara Thomson of Thomson
Data Analysis
• Three files required
– Exposure File
– Coverage File
– Claims File
• Coverage File will permit analysis by impairment
– will be able to capture full benefit and partial benefits
• Plan for publication of report is October of 2010
– could be significant delays depending on timing and
quality of data submissions
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Canadian Individual Critical
Illness Morbidity Study
• Coverage file may be time consuming to produce
in the first year
– Requires knowledge of what conditions are covered
under all contracts sold over time
– If not stored on system, could require manually pulling
contracts
• Common link between three submission files is key
• Submission request reflects the fact that there can
be partial benefit payments
• Unsure of overlap impact
– A stroke followed by a coma… which one is reported?
• Expect to see higher proportion of litigated claims
• Enough data is there to do a mortality or lapse
study as well, though not in scope for 2010