title: Insurance problems among inflammatory bowel disease patients: results of a Dutch population based study.
abstract: OBJECTIVE
  The majority of patients with inflammatory bowel disease (IBD) have a normal life expectancy and therefore should not be weighted when applying for life assurance. There is scant literature on this topic. In this study our aim was to document and compare the incidence of difficulties in application for life and medical insurance in a population based cohort of IBD patients and matched population controls.
  
  
  METHODS
  A population based case control study of 1126 IBD patients and 1723 controls. Based on a detailed questionnaire, the frequency and type of difficulties encountered when applying for life and medical insurance in matched IBD and control populations were appraised.
  
  
  RESULTS
  In comparison with controls, IBD patients had an 87-fold increased risk of encountering difficulties when applying for life assurance (odds ratio (OR) 87 (95% confidence interval (CI) 31-246)), with a heavily weighted premium being the most common problem. Patients of high educational status, with continuous disease activity, and who smoked had the highest odds of encountering such problems. Medical insurance difficulties were fivefold more common in IBD patients compared with controls (OR 5.4 (95% CI 2.3-13)) although no specific disease or patient characteristics were identified as associated with such difficulties.
  
  
  CONCLUSIONS
  This is the first detailed case control study that has investigated insurance difficulties among IBD patients. Acquiring life and medical insurance constituted a major problem for IBD patients in this study. These results are likely to be more widely representative given that most insurance companies use international guidelines for risk assessment. In view of the recent advances in therapy and promising survival data on IBD patients, evidence based guidelines for risk assessment of IBD patients by insurance companies should be drawn up to prevent possible discriminatory practices.
authors.affiliation: Department of Gastroenterology, University Hospital Maastricht, Maastricht, The Netherlands.
authors.forename: M G V M
authors.initials: MG
authors.lastname: Russel
authors.forename: B M
authors.initials: BM
authors.lastname: Ryan
authors.forename: P C
authors.initials: PC
authors.lastname: Dagnelie
authors.forename: M
authors.initials: M
authors.lastname: de Rooij
authors.forename: J
authors.initials: J
authors.lastname: Sijbrandij
authors.forename: A
authors.initials: A
authors.lastname: Feleus
authors.forename: M
authors.initials: M
authors.lastname: Hesselink
authors.forename: J W
authors.initials: JW
authors.lastname: Muris
authors.forename: R
authors.initials: R
authors.lastname: Stockbrugger
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000191:economics* / Q000534:rehabilitation*; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D015273:Insurance Selection Bias; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007352:Insurance, Life / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016017:Odds Ratio; D011287:Prejudice; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D012907:Smoking