Fear of heart attacks and strokes were once the dominant motivation behind Australian consumers buying life insurance policies – they were both much more likely and deadly hazards of post-war Western life before public health awareness campaigns about smoking, stress and diet began to transform our workplaces and lifestyles.
But technical advances in intensive care surgery dramatically transformed the survivability of heart disease at least as much as research into its risk factors and progress – and in the process gave birth to critical illness (CI) insurance, which we now know as trauma cover.
Critical illness insurance is the most successful risk product but also the most needed.
Before there were sophisticated pathology tests and imaging techniques that allowed recognition of different forms of heart attacks [see IRP Vol 33, Issue 6 page 62–66], cardiovascular medicine was beholden to a series of surgical milestones that focused on the bypass of critically narrowed arteries through open-heart surgery.
Here, the chest is cut open, allowing direct access to the beating heart; a technique pioneered in the early 1950s and culminated in thefirst human heart transplant in South Africa in 1967, performed by Dr Christiaan Barnard.
The procedure made headlines worldwide, advanced cardiothoracic surgery by leaps and bounds, saved thousands of lives and propelled DrBarnard into lifelong celebrity overnight.
Although Christiaan became the international household name, his brother and assistant surgeon during the operation, Marius, left an equally monumental legacy to life insurance – despite having no previous knowledge of the field.
“Marius Barnard invented the first trauma policy in 1983 in South Africa,” says Dr Sally Phillips, Head of Underwriting and Claims at Macquarie Life. “He developed it after hearing from his patients how they struggled financially following the diagnosis and treatment of their heart disease.”
Macquarie Life is currently running a series of Australian adviser roadshows featuring a video interview with Dr Barnard, which outlines how CI insurance started and includes him outlining the benefits of Macquarie Life Active, which combines trauma and TPD policies.
In a 2004 presentation at a Healthcare Conference for UK actuaries, Dr Barnard outlined how originally CI insurance covered just four conditions: heart attack, stroke, cancer and coronary artery bypass surgery.
Now most policies cover over two dozen conditions, Dr Barnard added, and despite initially slow sales, “Today CI insurance is not only accepted as the most successful risk product but also the most needed.”
However, it’s one of the original four conditions – coronary artery bypass surgery – that has seen the most change in cardiac surgery, making it even do away with the suffix ‘thoracic’ in some contexts, with greatest impacts upon trauma insurance policies.
“From an insurance perspective, the biggest advance is angioplasty, where a small balloon is inserted into a coronary artery then inflated to allow a stent to be implanted and so keep the artery open,” says Dr Sally Phillips. Thus there is no need for a coronary artery bypass graft (aka CABG) with another, less congested vessel, with its attendant risk.
Often this balloon is fed through a vessel running from the groin via a small incision – thus no need for sawing through the sternum and retracting the ribcage, with its massive risk of infection and cosmetic result of a huge scar.
However, 20 years ago angioplasty was not covered in trauma policies for CABG so patients would elect for open-heart surgery – despite its obvious drawbacks – because they at least got cover. Hence payouts were much larger and cardiologists complained that they were obliged to perform more risky operations when a safer procedure was available, explains Dr Phillips.
“From the late 90s into the early 2000s, trauma policies started to add cover for angioplasty, which was one of the first partial payments,” says Dr Phillips. However, she adds that most bypasses are still done open-heart style because the expertise for keyhole bypasstechniques is not yet widespread.
The shift from CABG to angioplasty and stenting has increased significantly around the world, with multiple stenting now increasing at a rate of about six per cent per annum, according to recent reports.
Although angioplasties spared coronary artery bypasses the necessity of a heart-lung machine and a large incision, stents –– effectively a tube of wire mesh –– did at first cause inflammation because the immune system rightly treated it as a foreign object. But in the last 10 years they have been coating stents with slow-release drugs that dampen inflammation and now they’re as good as a CABG.
The shift from CABG to angioplasty and stenting has increased significantly around the world, with multiple stenting now increasing at a rate of about six per cent per annum, according to recent reports.
Single stent insertion attracts a proportionally lower benefit to the traditional CABG payment but when multiple stents are inserted into several vessels, some companies in the market recognise this as being equivalent to a CABG and pay a similar benefit.
With the development of less invasive surgery to repair a number of cardiac conditions, including heart-valve repair and congenital heart defects, there is opportunity to cover them under the trauma product with benefits that reflect the lesser impact such surgery has ona person’s life. We are now seeing such benefits appearing in the Australian market after they achieved popularity in South Africa.
It is a way of ensuring that the insurance industry stays abreast of the innovation happening in cardiology today, continuing in the tradition of the famous Barnard brothers.
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