Insurance, Endometriosis and the use of medicinal cannabis in Australia: A qualitative analysis

Background Endometriosis is a complex multi-systemic disease that costs Australia $9.7Bill per annum, 84% of this cost is workplace absenteeism and lost productivity. Public insurance coverage via Medicare is limited, so access to disability, trauma and private health insurance is critically important as claim proceeds can help fund private treatments like surgery, allied health care, medications and other living costs. Patients report improved symptom management and capacity to work when consuming medical cannabis for endometriosis, however we currently do not know how this impacts people’s ability to obtain, maintain and claim on these insurance covers nor how insurers are approaching these topics. Methods Small group and one-on-one interviews were conducted with two cohorts. One cohort consisted of ten endometriosis patients and the second cohort was comprised of nine life insurance sector stakeholders. We sought to understand how the challenges with diagnosis, treatments, co-morbidities, underwriting, product gaps, knowledge, and training on endometriosis and use of cannabis impacted experiences with insurances. Interviews took between thirty minutes to an hour and were conducted between April and December 2023. Data were analysed using thematic analysis. Results Insurers identified gaps in their knowledge concerning endometriosis prevalence and rates of medical cannabis use amongst their customer base, compounded by a lack of training on medical underwriting and claims management around these issues. Consumers highlighted inadequacies and inequities in insurance coverage and financial support for people with endometriosis, particularly those consuming medical cannabis. Improved public health funding to reduce those with endometriosis needing to access their private superannuation savings before retirement to fund essential treatments like surgery due to public hospital delays and underinsurance, was a near universal view expressed by participants. Conclusions Australian clinical and insurance medicine settings for endometriosis were found to be unfit for purpose. Systemic bias and underfunding of women’s medicine has influenced poor coverage in public and private insurances, leading to limited reimbursement settings for consumers with endometriosis compared to other chronic illness. Improving endometriosis evaluation techniques and updating guidelines on re-emerging interventions like medical cannabis are needed to improve access to financial reimbursement across public and private insurance domains.