predominantly based on the principle of solidarity, and private health insurance,
which is founded on the principle of equivalence.
For instance, in the private health insurance, classification of applicants or
insured persons and their level of health risk are crucial for the determination of
premiums, limitation of benefits, or even denial of insurance.
All accomplishments and results of individualized medicine are in principle
interesting to the private health insurer because they offer better possibilities for
risk assessment of applicants wishing to take out private health insurance. There are
many controversies, however, especially regarding applicants with high risk of
illness:
- Will they find it even harder to qualify to take insurance at all or only under very
unfavorable circumstances? - Will they be able to access services of individualized medicine that could be of
special benefit to them, or will they be faced with great (financial) obstacles? - As a result, will they concentrate in compulsory health insurance, or even
- fail to take tests, so as not to be bound by the duty to inform the insurer about the
discovered risks?^42
In compulsory health insurance, personalized medicine presents other kinds of
challenges. Here, the amount of contributions and the scope of benefits do not
depend on individual risks. The question is, however, can the services of individual
medicine be part of the standard catalogue of benefits and to what extent?^43 It seems
that the quality and cost-effectiveness of health care could be the guiding principles
for the integration of personalized medicine in compulsory health insurance. The
accent could be placed on the interpretation of necessity for such services, as well as
the evidence of their scientific value.^44
As rightly concluded in the 2009 Report of the German Bundestag, the benefits
of predictive health information based on biomarkers as a qualifying criterion for
health insurance, which undoubtedly limit the individual self-determination, should
be balanced against the interests of a solidarity-based community.^45 In order to
legitimize any restriction, a measure should be proven as efficient and have a
favorable risk–benefit ratio and acceptable cost–benefit ratio. So far, the evidence
of these conditions remains largely anecdotal.^46
Decisive role should be given to the principle of equality and equal treatment of
all predictive health information. The legal concept of “predictive health informa-
tion” should be defined and regulated.
(^42) Deutscher Bundestag ( 2009 ), pp. 15 and 148; Damm ( 2011 ), p. 12; Vogenberg et al. (2010a),
p. 642. On possible future development strategies for integration of personalised medicine in
health insurance, see, e.g., Vogenberg et al. (2010b).
(^43) Damm ( 2011 ), p. 12.
(^44) Deutscher Bundestag ( 2009 ), p. 15; Raspe ( 2012 ), p. 64.
(^45) Deutscher Bundestag ( 2009 ), pp. 15 and 148.
(^46) Bottinger ( 2007 ), p. 20.
40 N. Bodiroga-Vukobrat and H. Horak