title: Health-based risk neutralization in private disability insurance.
abstract: Exclusions are used by insurers to neutralize higher than average risks of sickness absence (SA). However, differentiating risk groups according to one's medical situation can be seen as discrimination against people with health problems in violation of a 2006 United Nations convention. The objective of this study is to investigate whether the risk of SA of insured persons with exclusions added to their insurance contract differs from the risk of persons without exclusions.
  
  
  
  A dynamic cohort of 15 632 applicants for private disability insurance at a company insuring only college and university educated self-employed in the Netherlands. Mean follow-up was 8.94 years. Duration and number of SA periods were derived from insurance data to calculate the hazard of SA periods and of recurrence of SA periods.
  
  
  
  Self-employed with an exclusion added to their insurance policy experienced a higher hazard of one or more periods of SA and on average more SA days than self-employed without an exclusion.
  
  
  
  Persons with an exclusion had a higher risk of SA than persons without an exclusion. The question to what extent an individual should benefit from being less vulnerable to disease and SA must be addressed in a larger societal context, taking other aspects of health inequality and solidarity into account as well.
authors.affiliation: Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands e.c.wijnvoord@umcg.nl.|Medical Department Movir Insurance, Netherlands.|Dutch Academic Center for Insurance Medicine.
authors.forename: Elisabeth C
authors.initials: EC
authors.lastname: Wijnvoord
authors.affiliation: Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands.|Dutch Academic Center for Insurance Medicine.|Medical Department Univé Insurance, Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Buitenhuis
authors.affiliation: Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Sandra
authors.initials: S
authors.lastname: Brouwer
authors.affiliation: Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Jac J L
authors.initials: JJ
authors.lastname: van der Klink
authors.affiliation: Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, Groningen, Netherlands.|Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands.
authors.forename: Michiel R
authors.initials: MR
authors.lastname: de Boer
mesh_terms: D000041:Absenteeism; D000328:Adult; D005260:Female; D006801:Humans; D018868:Insurance, Disability / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017149:Private Sector; D020379:Risk Adjustment / Q000706:statistics & numerical data*