Same Diagnosis, Different Risk:
Risk assessment in today’s international health insurance
When a person applies for international health insurance, one of the first steps is risk assessment — the process by which the insurer analyzes the applicant’s health profile to determine terms of their policy. Simply put, this involves understanding the person’s health condition and how certain factors might influence future medical care.
In the past, this assessment was based primarily on specific diagnoses. Having or having had a particular condition directly influenced the decision to accept, limit or exclude certain coverages.
“In the past, if a patient had, for example, a heart attack, everyone was assessed in practically the same way. Today, that’s changed,” explains Dr. Juan Carlos Velázquez, Vice President & Chief Medical Officer at VUMI®.
Beyond the Diagnosis
Traditionally, risk assessment tended to group patients into similar categories. A specific diagnosis often led to a standardized decision.
Today, two people with the same medical history may have different profiles depending on how they’ve managed their condition and their overall health status.
“It’s no longer just about the disease, but about understanding the patient as a whole,” notes Dr. Velázquez.
This involves analyzing factors that include:
❂ Management of the condition
❂ Medical follow-up
❂ Adherence to treatment
❂ The patient’s stability
For example, a patient with a controlled condition who has had constant monitoring would not have the same risk as one who had a similar diagnosis, but who had not done the indicated follow-up procedures. Although the diagnosis is the same, the level of risk is not. That difference is now a central part of the analysis.
From a snapshot to a story
Previously, analysis was based on a “snapshot” of the patient at a specific moment. Today, their progression is considered: How has their health been? Have they had relapses? Is their condition stable?
“We are moving from a static assessment to a much more dynamic view of risk,” explains Dr. Velázquez.
This allows us to distinguish between cases that previously would have been assessed the same way, but which in reality have very different prognoses.
Better, more accurate assessment
In the context of international health insurance, this approach allows for a more detailed analysis of each profile.
Factors such as continuity of care, medical follow-up, and condition management provide key information for a more accurate assessment.
Rather than applying general criteria, the goal today is to better understand each case before making a decision.
An approach that truly makes a difference
Risk assessment is moving away from more rigid models to a more comprehensive view of the patient.
Cases are now analyzed alongside other factors that offer up a clearer understanding of each patient’s condition.
