Health Insurance Risk Selection Driven by the Sub-health Concept: A Logical Analysis from Lifestyle Intervention to Major Disease Prevention

Section 6 Application of the Sub-health Concept in Health Insurance Health insurance takes human health as the insured object and disability, incapacity, and death caused by illness, childbirth, accidents, and related medical expenses as insured events. Insurance companies compensate the insured for expenses or losses incurred due to illness or accidents through methods such as disease insurance, medical insurance, disability income loss insurance, and long-term care insurance. "Illness" must be caused by some internal cause within the body, that is, abnormal function resulting from lesions in one or more organs, tissues, or even systems, leading to various pathological manifestations. Furthermore, health insurance also covers all personal risks not covered by life insurance or accident insurance. Therefore, the scope of health insurance is very broad. Sub-health, as a third state of the human body, is an intermediate state between health and illness. If it transforms into health, it can be insured at the standard rate; otherwise, underwriting may be delayed or denied. Two issues deserve attention here. First, regarding the selection of personal risk during the underwriting process, it's crucial to ensure that eligible insured individuals are insured, or to include various insured individuals within the scope of those meeting specific conditions, reflecting the principle of fairness in insurance. Second, there's the issue of disease prevention after underwriting. Integrating disease prevention into the daily operations of life insurance can potentially prevent or delay the onset of illness. Both scenarios reduce payouts, improve the insurance company's economic efficiency, and simultaneously generate significant social benefits, highlighting the insurance company's positive social impact. Based on the concept of sub-health and current regulations for the insurance industry, health products must continuously adapt to new demands, raising the issue of product innovation. The design of any health insurance product aims to mitigate health risks and reduce the loss of personal value or economic losses caused by poor health. The concept of sub-health also has significant application value in the sales of health insurance products. I. Application of the Sub-health Concept in Health Insurance Risk Selection Epidemiological surveys of sub-health indicate that only 5% of the world's population is truly healthy, 20% is diagnosed with illness, and 75% is in a sub-healthy state. While the proportion may vary across different regions, one thing is certain: the proportion of people in a sub-healthy state is relatively high. From this perspective, firstly, life insurance only covers healthy individuals, which is clearly insufficient to cover the entire population. Sub-healthy individuals, as long as they meet the underwriting criteria, can also be insured; only in this way can the law of large numbers be applied. Secondly, the calculation principles of health insurance should be reflected. Grouping people with similar conditions together, those meeting the standard premium rate will be insured, while those not meeting the standard premium will be insured at an additional rate. This aims to fully reflect the principle of fairness in insurance. Thirdly, those whose physical condition and other conditions do not meet the underwriting criteria will not be insured. Sub-health is related to lifestyle habits. Most people in a sub-healthy state lack healthy lifestyle habits. They not only overeat but also skip meals and drinks. Overeating and drinking easily lead to weight gain, while skipping breakfast or dinner can damage the stomach, making it difficult to work energetically and accelerating aging. Meanwhile, a lack of proper dietary balance prevents the body from receiving balanced nutrition. Excessive fat intake raises blood lipids, excessive protein intake raises cholesterol, and excessive sugar intake burdens the pancreas. Late, long, and heavy dinners are detrimental to sleep, easily leading to weight gain, indigestion, and insomnia. Some people dislike drinking water; dehydration can easily lead to constipation, kidney stones, gout, and other diseases. Insufficient sleep and irregular rest are also major culprits of sub-health. Modern people face high work pressure and a fast-paced lifestyle, causing many office workers to frequently work overtime late into the night. This disrupts the biological clock, leading to premature hair loss, baldness, memory decline, irritability, headaches, tinnitus, and other symptoms, even after medical examinations reveal no specific illness. Among lifestyle habits, smoking and drinking have the greatest impact on health; the dangers of smoking have already been discussed and will not be repeated here. Excessive alcohol consumption disrupts normal dietary control and hinders blood sugar stability; it also negatively impacts blood lipid control, increases the burden on the liver, and long-term drinking can easily lead to fatty liver; alcohol consumption easily causes obesity, especially abdominal obesity; combining smoking and drinking is even more harmful to health, because while nicotine in cigarettes can lower alcohol concentration, it cannot reduce acetaldehyde produced during alcohol breakdown, causing acetaldehyde to cause greater toxicity to the brain, liver, heart, and other organs. Sub-health is related to occupation and work stress. The high proportion of people in a sub-healthy state is mainly related to increased work pressure and a faster pace of life. Long hours of full-load work every day keep people in a state of high tension, leading to fatigue, tinnitus, palpitations, and insomnia; long-term pressure and tension seriously affect the nervous and cardiovascular systems, inducing hypertension, coronary heart disease, migraines, and affecting the endocrine system, causing menstrual disorders in women and impotence in men, and in severe cases, even sudden death. Sub-health is also related to occupation. Those who work in or are exposed to the following occupations for extended periods are considered high-risk for cancer: asbestos, benzene, cadmium, chromium, nickel, arsenic, wood chips, radiation, radon, ultraviolet radiation, alkylating agents, aromatic amines, polycyclic aromatic hydrocarbons, diethylstilbestrol, vinyl chloride, 4-aminobiphenyl, dichloromethyl ether, coal smoke and tar, pesticides, rubber, metallurgy, and furniture manufacturing. Long-term exposure to harmful toxins in these occupations greatly increases the risk of developing a sub-healthy state conducive to cancer. If preventative measures against occupational diseases are neglected, serious illnesses such as cancer may result. In fact, the cancer rate among employees in these occupations is significantly higher than in other groups. Frequent exposure to coal smoke or fumes is also a concern, as the combustion products of coal, coal tar, or other oils are carcinogenic. Workers in the gas, asphalt, and coking industries have a higher incidence of lung cancer than the general population. This is because the combustion products from these occupations keep these workers in a sub-healthy state, making them less resistant to cancer cell proliferation, thus increasing their risk of developing cancer. Sub-health is also related to family medical history. Individuals with a family history of esophageal or stomach cancer, especially if cancer is present in every generation across two or three generations, may have a genetic predisposition to the disease. People with a close relative history of esophageal or stomach cancer may have shared similar living environments and been exposed to similar carcinogenic factors. Those with a family history of ovarian, breast, or colon cancer have a higher incidence rate than other groups. Those with a family history of colorectal cancer have a four times higher risk. Women with a family history of breast cancer, particularly first-degree relatives, have a two to three times higher risk. Women who have had cancer in one breast also have a higher risk of developing cancer in the other breast. The family plays a crucial role in diabetes prevention. Families with a history of diabetes, such as parents, children, or siblings, are at high risk. The incidence of diabetes among relatives with diabetes is 4 to 10 times higher than among non-diabetic relatives. The concordance rate of type 2 diabetes in monozygotic twins is as high as 90%, indicating that heredity plays a significant role in the development of diabetes. Children whose parents have hypertension have a significantly higher chance of developing hypertension than those whose parents have normal blood pressure. These examples sufficiently illustrate the link between family history and sub-health. The family's living environment, lifestyle, and genetic factors contribute to a sub-healthy state, which gradually progresses to illness, leading to serious diseases. Sub-health is a major cause of hypertension, which is a leading cause of coronary heart disease, myocardial infarction, and stroke. Several major health problems are related to hypertension. Many risk factors for sub-health are also risk factors for hypertension. For example, accountants, drivers, stock traders, and ticket sellers who are under constant stress have a higher probability of developing hypertension. Obesity, high salt intake, smoking, drinking, prolonged exposure to noise pollution, and a strong genetic predisposition are all risk factors for sub-health, and hypertension is prevalent among these groups. High blood lipids and high blood sugar are also associated with sub-health in people with hypertension. The incidence of coronary heart disease in hypertensive patients is more than four times higher than in those with normal blood pressure. Hypertension is an independent risk factor for coronary heart disease, and effective treatment of hypertension can reduce or delay the onset of coronary heart disease. Sub-health is the root cause of coronary heart disease and myocardial infarction, while hypertension and hyperlipidemia are the main causes of these conditions. Hypertension is the leading cause of stroke, and also a major culprit. Diabetes is related to high blood sugar, and consequently, hypertension is also related to diabetes. Hypertension is a major cause of several serious modern diseases.