The prevalence of diabetes is increasing worldwide, and the trend is putting health insurance systems under increasing pressure. Improved education and additional prevention measures are needed to keep the associated costs under control. In addition, insurers must offer special products to ensure the highest possible level of insurability.

Type 2 diabetes, the form that affects nine out of ten sufferers, is caused by insulin resistance. This is triggered by genetic factors, as well as by secondary resistance mechanisms, such as excess body weight and lack of exercise. Living with permanently high blood sugar levels can have many consequences – some of them fatal: damage to the retina, diseases of the nervous system (neuropathy), renal insufficiency requiring dialysis, amputations, heart attack and stroke.

Diabetes is already one of the most prevalent illnesses, and the figures are set to increase. The International Diabetes Federation (IDF) estimates that the number of diabetics will rise from 415 million today to 642 million by 2040. The bulk of the increase will probably stem from emerging and developing countries, where, to an increasing degree, people are adopting western lifestyles as economic prosperity increases. One dangerous aspect of this disease is that, for a long time, many of those affected only develop non-specific symptoms such as fatigue, weakness, blurred vision and an increased susceptibility to infection. As a result, the disease itself is not diagnosed for years, by which time complications from the diabetes have already developed. And yet it would be relatively simple to tackle the problem head on at an early stage through healthier nutrition and more exercise.

Diabetes is an expensive disease because of its chronic nature and the serious complications that accompany it: According to the IDF, an estimated US$ 673bn was spent on the disease in 2015 – this is equivalent to 12% of total healthcare expenditure for adults worldwide. In 2040, the total cost is likely to be in excess of US$ 802bn. Adding to the direct medical costs are indirect costs, estimated to be on at least the same scale, that are incurred from missed working hours and loss of productivity.

  

Prevention and early identification play a key role in combating this disease. This is a task for the whole of society, and the insurance industry can play its part too. According to a study, lifestyle change can reduce the risk for diabetes by 49.4%, hence represent a good value for money (source:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3985133/). Insurers have had positive experience with special programmes for diabetics in Abu Dhabi. The rate of hospital admissions there among the participants in the programme has dropped by 60% in recent years. Provided they are properly set up, programmes like this are definitely worthwhile, not least because a change in lifestyle lowers the risk of contracting a number of other diseases. The positive knock-on effects have been demonstrated, for example with regard to developing lung, breast and bowel cancer, depression, high blood pressure, back pain, and even dementia.

The insurance industry can help spread such programmes by incorporating them as integral components in innovative insurance products. The approach is to enroll diabetics for insurance at an early stage of the disease, and to ensure that accompanying health programmes bring about an alteration in lifestyle and behaviour. The policy design can include out of pockets to provide further incentives for health-conscious behaviour. In addition, tailored products are required for countries with low or medium income levels.

As a reinsurer with global experience in managing health risks, Munich Re provides support for innovation from the analysis and conception stages through to implementation. This was the case, for example, with a new product at Apollo Munich Health Insurance in India that is tailored to meet the needs of diabetes patients. Sophisticated methods of structuring and evaluating big data are important in this context for setting up the right programmes for the right target groups.

Source of figures: International Diabetes Federation, Diabetes Atlas 2015