RECORD – A health insurance company is launching an offer in France which gives entitlement to benefits depending on behavior. A risky but inevitable system, according to Emmannuel Hirsch.
In July, the international insurance group Generali announced the launch in Germany of a flexible contract depending on behavior. Policyholders who take care of their health, with supporting evidence, benefit from reductions on insurance premiums ranging from 11 to 16%. These proofs are organic market receipts, proof of preventive medical visits, data from health applications or even gym registrations …
Three months later, as he had announced to Why Doctor, Generali extends this concept to France. With some adjustments, since insurance regulations and the philosophy underlying support in the country do not allow the rates to be adjusted. The group has thus found another bonus system, which is not intended for insured individuals but for employees of companies. Those who demonstrate good health will be offered reduction coupons from Generali partners (Club Med, Weight Watchers, etc.).
These developments raise many questions regarding data confidentiality and the power given to insurance companies. They upset the universalist model of care in France. However, they seem almost inevitable. Prof. Emmanuel Hirsch heads the ethics space for the Ile-de-France region. He comes back to the need to anticipate the perverse effects of these insurance contracts which risk becoming widespread in France.
Do these bonus contracts really have the capacity to improve disease prevention?
Emmanuel Hirsch: Indeed, they allow a form of educational accountability of the person vis-à-vis his health, as do health applications. It is the positive aspect of this orientation that the insurance companies are taking. In return for the premiums, the insured person limits his exposure to preventable illnesses. In addition, he saves money by taking care of his health. This is why everyone sees the benefits of developing this type of contract, but you have to think about the consequences.
However, the threats are numerous, starting with that which weighs on the confidentiality of the data. We can see that the concept of medical confidentiality is evolving. The shared medical record will be increasingly shared and access to this information will give insurers greater power. With genomic medicine and big data, we will have increasingly detailed knowledge of the risk of disease. For 150 euros, you can already send your blood or saliva to companies to assess your genetic risk of contracting a pathology! So we will see profiling taking place. There will be the right clients for the insurers, who will be coveted; and bad policyholders.
So we are moving towards discriminatory care?
Emmanuel Hirsch: We observe that we are in an increasingly normative and intrusive logic. It is the insurer who will end up explaining what the ideal weight is, the right rate of such a biological marker, the appropriate lifestyle. However, prevention is very socio-cultural. In an environment that values and supports, we are more inclined to avoid risks.
On the contrary, a socially vulnerable person does not have the same capacity to take responsibility for their health, because they neglect themselves more than others. Studies show that tobacco or alcohol addictions are more frequent in this population; moreover, these people do not have the necessary resources to eat organic food, for example. All these elements must be debated and weighed before the generalization of these insurance à la carte takes place for good. If we do not discuss these risks, then we will weaken the most vulnerable, deepen injustices.
Isn’t this model undermining our universal model of care?
Emmanuel Hirsch: Of course, but evolution is underway, there is no point in sticking your head in the sand and clinging to its main principles. The problem goes beyond the French framework, with insurers largely belonging to international groups. In addition, with the improvement of genetic screening, some insured people say that if they have no risk of developing a disease, there is no reason to pay for insurance. Insurers, for their part, explain that they will no longer insure people who present excessively high risk, or that they will increase premiums.
There is currently a moratorium. It is absolutely necessary to anticipate these developments, to make society responsible, to adjust the regulations to avoid the perverse effects of these contracts. It is not only a medical issue of public health, but also a social and political one. We need to get on with this issue and not deal with it in a hurry, once it’s already there.
Have the ethical and political bodies already initiated this reflection?
Emmanuel Hirsch: Ethical bodies must ask themselves questions about their ability to anticipate. They are a bit overwhelmed by reality. Either they are expressed urgently, when such and such an innovation has emerged and an opinion must be provided; or they remain in a rigid principled position. Currently, there are hundreds of thousands of health applications and just as much health data passing through an anarchic context. We are in a completely deregulated system and the ethical bodies remain silent.
In our ethical space dedicated to reflection on degenerative neurological diseases, we had a very interesting textbook case. We know that treatments against Alzheimer’s disease are not effective because they are delivered too late. Currently, technologies are available to predict the risk 20 years before the onset of the pathology. Medicines should in fact be given to people who are healthy, but at risk. But what to say to the insurance companies? In order for them to pay for the treatments, they will know the situation, but then they will increase the premiums, or will not insure, in view of this risk. It is said that a healthy person is a sick person who ignores himself and this has never been so true with anticipatory medicine. All these elements constitute new challenges for insurers and policyholders.
.
