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In a retrospective questionnaire survey, 129 Dutch patients with ankylosing spondylitis (AS) were asked if they had had difficulties in arranging a medical insurance, an additional work disability insurance, or a life assurance. Patients who had arranged the insurance after diagnosis were compared with those who had arranged the insurance before diagnosis. A restraint in arranging the insurance was defined as (a) a higher premium; (b) exclusion for AS related problems. Ninety four (73%) patients were male, with a mean (SD) age of 49 (10) years, mean (SD) disease duration of 12 (10) years, and mean (SD) educational level of 13 (4) years. One hundred and three (80%) were married, age and sex adjusted employment was 57% and age and sex adjusted work disability was 33%. Table 1 compares the number of patients who had arranged the insurance before or after diagnosis, and within each group the proportion of patients for whom restrictions in the contract were imposed.
Despite the small number of patients in this survey, it is clear that in the Netherlands, at least for medical insurance and life assurance, a substantial number of patients with AS encounter problems. This is especially relevant because AS is increasingly diagnosed at younger age. Because there is evidence that health resource use and work disability are especially increased in patients with more severe disease1–4 and because it has been shown that mortality is only increased in patients with longstanding or complicated disease,5–8 the course of disease severity should be taken into account when performing insurance risk assessments. It should be discussed how these considerations might be implemented in practice.
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