A New Disease Shakes the World: SARS Mosquito Nets Saving Lives An Ounce of Prevention... Medical Insurance to the Rescue

Medical Insurance to the Rescue

Despite the best prevention measures, infections can still occur. These cases require appropriate medical treatment, which can be costly. Medical expenses rise with prolonged treatment, but treatments that only take a day or two are often not covered by medical insurance. Sumitomo Life Insurance Company’s new Doctor OK policy, which rolled out in October 2004, is uniquely suited to this contemporary medical system. For example, four days’ worth of medical expenses can be paid out for only one day in the hospital. Most medical insurance offered by Japanese life insurers has traditionally paid out claims only after five or more days in the hospital, so Doctor OK’s payment of four days’ worth of benefits for even an out-patient visit is truly revolutionary. A pattern of ever-shorter hospital stays is taking root in Japan, partially because of government efforts to control medical costs. Currently, patients can be discharged just one or two days after or even on the same day as their operations. Powerful new antibiotics also mean that infections that once required a week in the hospital can now be treated in one night. It was with these trends in mind that Doctor OK was developed. Yasuhiro Nariyama, assistant to the director of the Product Development Department, Product Division, Sumitomo Life Insurance, discusses the effect of paying out claims without hospital admission: “Healthcare used to be free for the elderly, but now they have to shoulder more and more of its costs. Often they should be hospitalized to treat the influenza, but many now resist a hospital stay because of its high costs. But those enrolled in our program don’t need to worry about the costs at all. This is how our insurance helps lower the psychological and financial barriers to hospitalization.” Doctor OK offers reimbursement for up to 180 days of hospitalization, and for an unlimited time for cancer treatment—some of the best coverage levels in the industry. Whether it’s AIDS or SARS, reimbursements are made regardless of the disease. And of course patients who contract diseases overseas but require coverage in Japan are eligible for care. Finally, no visit to the doctor is required for people under 75 years of age who want to sign up for the plan. “Right now the only infectious disease that could affect insurance rates is influenza. Of course, we also have to study new diseases when designing new insurance programs.” According to Nariyama, asthma and atopic dermatitis from pets are on the rise. These are not infectious diseases per se, but they do raise the possibility of diseases springing from the many bacteria and viruses that pets bring into the home.

Yasuhiro Nariyama, assistant to the director, Product Development Dept., Product Division, Sumitomo Life Insurance

Influenza is particularly dangerous to the elderly. It often leads to pneumonia, and, when cardiorespiratory or other chronic diseases are present, can result in death. Vaccines are the most effective countermeasure, but inoculation rates are on the decline in Japan, in contrast with the situation in North America and Europe.

Eradicating Smallpox

Zambia, a country in southern Africa, has a population of 10.7 million and an AIDS population of 1.2 million. The infection rate among adults is 21.5%, and the average life expectancy is about 32 years. The government fears that, at this rate, the country itself could collapse. One historical analogy is smallpox. This disease, thought to exist since the days of ancient Egypt, spread throughout Europe during the crusades in the 11th and 12th centuries. As many as 50 million people were infected worldwide in 1950, but by May 8, 1980, the WHO was able to declare that smallpox had been eradicated. This was thanks to the smallpox vaccine invented by Edward Jenner and a worldwide inoculation program. Similarly, a polio epidemic swept through Japan in the 1960s, but similar inoculation programs have almost completely eliminated the disease as a threat to health today. In 2004, only six countries—among them India, Afghanistan, and Nigeria—saw any occurrence of the disease at all. Those in India account for 80% of the world’s polio cases, and even there the number is declining dramatically. It is highly possible that the worldwide goal of reaching zero new cases will be achieved by 2005. The battle against infectious diseases cannot be won with new medical treatments or drugs alone. Political strife like wars (civil and otherwise), economic issues like poverty, and other problems stemming from cultural and religious attitudes, must all be confronted if we are to make headway against infectious disease. This will require both time and money, and in the end it may not be possible to overcome all such illnesses. But the more such efforts spread, the more effect they will have. Given the possibilities of human ingenuity, the day could well be near when humankind’s struggle against infectious diseases comes to an end.

(Data collected October 2004)