The "Personalised Medicine Revolution" will disrupt current medical practices, changing forever the diagnosis and treatment of diseases, said health keynote speaker Dr Pieter Cullis, Chair, Personalised Medicine Initiative at the University of British Columbia, Canada. He was speaking at the Singapore Actuarial Society's Health and Retirement Conference 2017 held last week.
Dr Cullis highlighted that what is now called healthcare is ‘sick-care’, with people treated after getting ill, not having had adequate information to practise effective preventive “healthcare”. Diseases are often detected too late with limited treatment success, and drugs are mostly prescribed on a “one-size-fits-all” basis, ignoring the fact that everyone is different.
Dr Cullis briefed the audience on how developments in molecular profiling (“Omic”-- genomics, proteomics, metabolomics and microbiomics) technology and analysis for individuals will reveal new biomarkers associated with health and disease. Data from molecular profiles not only help stratify patients to receive the most appropriate therapy; but outliers in the indicators could also result in early preventive measures to stave off diseases. The process moves power from the healthcare system to the consumer, said Dr Cullis, with doctors increasingly playing a ‘health-coach’ role. He expressed confidence that the current CAD$1,000 (US$800) cost of the profiling test would drop in future, and tests would grow more comprehensive.
Personalised data and wearables influence user behaviour
Also discussed at the conference was the use of data at a more basic level to influence individual consumer behaviour and lifestyles, helping to lower claims for life and health insurers.
Mr Thomas Dijohn, Vice-President of Asia-Pacific at dacadoo, a Gen Re partner that deals with digital mobile lifestyle solutions, explained how the enormous number of wearable devices and associated apps capturing digital data about people’s health, will be a “gold mine” for the insurance industry and help to lower claims. Through getting people to understand their health in a simple way, using personalised feedback and health score and a rewards system for healthy behaviour, wearables enable a conversation to engage the policyholder that builds his “stickiness” to the insurer’s programme.
The major implications of the use of data in the longer term are accelerated and dynamic underwriting. Accelerated or even instant underwriting does away with intrusive tests as insurers are able to use the additional third-party health data available. Dynamic “pay-as-you-live” underwriting, assessing actual risk at a point in time, will open a lot more opportunities for insurers, who could one day offer high-margin products to specific segments who are currently uninsurable with existing conditions, but are able to manage their disease well.
Increasing employers’ role in retirement
Singapore’s Central Provident Fund (CPF) is a solid foundation, but there is a need to diversify the retirement proposition to cater to the additional needs for retirement savings today, said Mr Mark Whatley of Milliman (Singapore), whose presentation addressed a less discussed aspect of the city-state’s retirement system—greater involvement by employers.
Currently, there are only around 20-30 employer-established (“Section 5”) schemes. Most employers are deterred from offering them due to numerous restrictions like no employee contributions and a lengthy approval process. Mr Whatley suggested that the legislation could be improved, to encourage employers to offer additional retirement benefits in Singapore. The government could also encourage more flexibility around the application of re-employment legislation and incentivise financial wellness initiatives by employers. Although 98% of private sector employees were offered re-employment at the minimum retirement age in 2015 with the same job scope and benefits, Mr Whatley is of the view that there could be structuring of alternative career paths to provide more options which may be preferred.
Decumulation and “rules of thumb”
Moving to financial planning for retirement, a lot of people focus on wealth accumulation but fewer think about decumulation—turning their savings into retirement income. Using a study conducted on his country, retirement keynoter Mr Daniel Musset, New Zealand Society of Actuaries showed how it is possible to use Rules of Thumb—user-friendly, simple and normalised principles, generally reliable in the absence of full advice—to help individuals approaching retirement achieve financial goals no matter their financial situations, risk preferences and commitments. The statistics and modelling assumptions he cited provided lively debate for the audience of number-savvy actuaries.
The Singapore Actuarial Society’s Health and Retirement Conference is an annual event. This year’s conference took place on 12-13 October 2017 and was attended by around 130 participants from the region.