Challenges of an Integrative and Personalised Health Care for Health Economics and the Insurance System

Objectives: Stratifying medicine is a topic of increasing importance in the public health system. There are several questions related to stratifying medicine. This paper reconsiders definitions, opportunities and risks related to stratifying medicine as well as the main challenges of stratifying medicine from the perspective of a public health insurance. Definition: The application of the term and the definition are important points to discuss. Terms such as stratified medicine, personalised medicine or individualised medicine are used. The Techniker Krankenkasse prefers stratifying medicine, because it usually means a medicine that tailors therapy to specific groups of patients by biomarkers. Opportunities and Risks: Stratifying medicine is associated with various hopes, e.g., the avoidance of ineffective therapies and early detection of diseases. But stratifying medicine also carries risks, such as an increase in the number of cases by treatment of disease risks, a duty for health and the weakening of the criteria of evidence-based medicine. Challenges: The complexity of stratifying medicine is a big challenge for all involved parties in the health system. A lot of interrelations are still not completely understood. So the statutory health insurance faces the challenge of making innovative therapy concepts accessible in a timely manner to all insured on the one hand but on the other hand also to protect the community from harmful therapies. Information and advice to patients related to stratifying medicine is of particular importance. The equitable distribution of fees for diagnosis and counselling presents a particular challenge. The solidarity principle of public health insurance may be challenged by social and ethical issues of stratifying medicine. Conclusion: Stratifying medicine offers great potential to improve medical care. However, false hopes must be avoided. Providers and payers should measure chances and risks of stratifying medicine together for the welfare of the patients.