Dr Marion Morkel, 6 August 2018
It has created a whole new underwriting world. As new diseases are diagnosed and ailments that previously went unnoticed start to reach numbers that demand our attention, the question that comes to many people’s minds is whether any of the issues and illnesses we are concerned about today, will still preoccupy the industry in the next few decades. Are we are heading for unchartered territories?
Some of the diseases that are starting to rake up life insurer’s claims include lifestyle-driven conditions and pain-related disorders. More and more people are claiming disability benefits for ailments such as musculoskeletal disorders, back pain, joint problems and other disorders that cause discomfort.
To a lesser extent, claims related to respiratory, mental and mood disorders as well as nervous system conditions, are also showing an uptick. This rising trend can be attributed to the fact that everything else, except for infectious diseases that the World Health Organisation (WHO) has pledged to eradicate, is rising.
The emergence of the ‘new set’ of diseases that are starting to dominate insurer’s claims is partly a symptom of people living longer.
Longitudinal studies have picked up that the amount of years that people live with a disease – called Disability-Adjusted Life Year (DALY) – has increased significantly over the past decade. What this means is that people are indeed living longer but their quality of life is not good. So, there is an increase in ill-health suffering which is why we are seeing a rise in diagnoses of newer diseases.
Notwithstanding these observed trends, lifestyle-related diseases continue to outpace all emerging disease burdens in South Africa. Diseases like hypertension, diabetes, heart diseases and cancers are still increasing and will most likely continue to make up the bulk of risk cover claims by 2030. So, while other disorders are showing an increase, we should pay more attention to those showing no signs of slowing down. Cardiovascular diseases for instance, have remained the biggest cause of death worldwide for decades. In severe illness claims, cancer is still the leading cause of claims and this will likely remain the case for years to come.
Even though DALY is difficult to measure in South Africa, since majority the population is not served by the formal insurance sector, data from medical schemes provides a proxy to gauge which chronic conditions are on the rise for the rest of the population. As reported by the Council of Medical Schemes (CMS), the top three disorders dominating medical schemes’ claims in 2016 were high blood pressure, cholesterol and diabetes.
Type two diabetes will probably be our biggest problem in 2030. The International Diabetes Federation estimates that South Africa’s current health budget will have to be tripled to cope with diabetes-related illnesses in 2030, if the country continues the current diabetes prevalence trajectory. Last year, the prevalence of diabetes in adults stood at 7.5% of the South African adult population.
The biggest cause of type two diabetes is obesity and it does not help that more than a quarter of South Africa’s population is clinically obese. What is even more concerning is the fact that 25% of South African children are overweight. They enter adulthood with an obesity burden which increases their likelihood to be diagnosed with type two diabetes at a much younger age. Diabetes increases the likelihood of complications like heart attacks, kidney failure, strokes and the amputation of limbs. These events will in turn shape our claims environment.