Given the digital revolution in the field of health, it is vital to maintain a system of health insurance that attends to the needs of all people, and is solidarity-based, inclusive and non-discriminatory.

GD – 10/2017

The European Economic and Social Committee (EESC) has published an opinion paper on the possible effects of the digital healthcare revolution on health insurance.  

Digitalisation does not replace social systems

The report was prepared by Belgian Alian Coheur, an expert on health insurance. It comes to the conclusion that due to the foreseeable effects of the ‘digital revolution’ it is vital to maintain a health insurance system that is for all people, and is solidarity-based, inclusive and non-discriminatory. Fair access to health services is accorded significant importance. In addition to a number of technical requirements, including ‘equal geographical coverage taking into account areas with poor coverage by digital operators’, the report also states that another condition for equal access, as part of implementing the digital revolution, is bridging the ‘digital divide’ in terms of use by the public, healthcare professionals and stakeholders in health insurance funds.  

EU-wide networking and true data protection

Another important precondition is interoperability of the entire digital architecture (e.g. databases and medical devices). The opinion expressly refers to the ‘protection of health data which must under no circumstances be used to the detriment of patients’. The opinion also makes reference to the issue of ‘hyper-empowerment’ where people are encouraged to manage their own individual health in the future. Specifically, the report refers to how predictive medicine and connected devices increase the amount of information available about individual health risks. Knowledge of these individual risks and differences between individuals’ understanding of these risks raises a number of ethical questions. Thus, digitalisation should be a means of strengthening ‘individual and collective capacity’.  

Electronic medical records and the personalisation of health

According to the EESC, personalisation of health is strongly linked to digitalisation. Thus, electronic medical records are becoming the focus of medical care. Not only could data be stored in the future with the service provider, but also theoretically on servers outside of Europe. This makes it difficult to state with certainty whether the required level of data security can be ensured. However, what is not disputed is that merged data would bring about important advancements in the research and treatment of diseases. The dynamic development towards the personalisation of medicine and treatment will result in an entirely new dimension for preventive medicine, using information gathered from genome mapping and its inherent predictive aspects. There will also be additional breakthroughs in eHealth mechanisms including ‘connected objects’ which fall under the heading of self-measuring, and which enable users to gain insights into their own health status.  


One of the questions raised in the opinion is the degree to which health insurance of tomorrow could use genome mapping to counter disease probabilities before they become an issue. Future health insurance management will also be affected by big data processing. However, the spectrum will continue to expand and could possibly improve healthcare providers’ reimbursement procedures. Specifically, the report refers to ‘digital disruptors’, including the risk that digital multinationals could ‘take control’ of data processing in health.  



Future message in the age of globalisation devotees

Critics put this opinion in the same basket as other opinions heard in the past from the EU. According to them, there is a lack of definition of the term ‘digital revolution’, especially when it comes to assessing hands-on practices and not just extrapolations of what is technically feasible. The EU model, caught up in various future problems that are seemingly unsolvable, provides a promising message for the future in an age of globalisation devotees by using the argumentative drama attributed to technical progress when using digital processes.  


In light of real system crises that exist in realising the legislative promises in many EU social models due to unresolved government debt, this is now an attractive topic for plans and actions. However, it is the complexity itself that makes a strict definition related to everyday life so indispensable. Whoever puts everyday healthcare services into private venture, such as the social systems of Greece, Latvia and many others, can hardly participate in the expensive investment required for the wondrous digital world of tomorrow.  


Differences in the robustness of legal structures within the EU States also make it difficult to transfer German legal certainty to other EU worlds. Thus, the broad demand for interoperability of networked systems would have considerable gaps, especially for patients who are accustomed to the German level of healthcare.  

Does EU-wide digitalisation promote standardised processes?

EU-wide digitalisation with everyday improvements of data flow control and information processes requires a series of completely standardised procedures; this applies to both medical and legal processes. The single social security number, as problematic as it is from the German perspective, is likely to be there from the start.  


The term ‘personalised medicine’ reintroduces us to a series of old acquaintances. The pharmaceutical sector, which was once ‘cluster medicine’, is now praised for its personalised approach ‘tailored to the individual’, at least for patented, expensive drugs, whose effectiveness and added value are difficult to prove with unloved ‘head-to-head’ studies.  


Risks and opportunities of genome mapping

All questions about opportunities and risks of genome mapping, including the resulting individual risk probabilities, are completely uncharted territory in terms of data privacy and protection. However, it is clear that if the data were ever to fall into the wrong hands, the consequences are not foreseeable. A regular laboratory diagnosis or even a prophylaxis treatment derived from this would in fact raise the question of where ‘health’ stops and ‘the need for treatment’ begins. The economic consequences would also be of significance. It is not just a question of ‘whether’ but rather ‘how’ future data technologies and social protection should be further developed. Church representatives have noted that, despite all these visions of future progress, a severely ill or dying human certainly needs to participate in future technology. However, it is in these difficult moments of a serious illness that emotional need for human care by doctors and nurses cannot be replaced. This is also a topic of debate across Europe, naturally far from the economic visions of various digital developments, at least when looking at the number of conferences corresponding to the topic.