Abstracts by key term: Health insurance companies
Health and long-term care insurance funds can evaluate insured persons' data. Various information obligations can arise from the data evaluation. These obligations arise first when a specific health risk to the insured person is identified. This requires that there is a sufficient probability of health damage. Health and long-term care insurance funds must also provide information if their data evaluation reveals that there is a possibility (not probability) of illness or the need for care in the foreseeable future that arises from the individual (life) circumstances of an insured person. Whether these thresholds are reached in each case is ultimately determined by medical science and health services research. Health and long-term care insurance funds must always be able to provide a comprehensible justification for how they arrived at their results and why they made which information decisions. These legal requirements limit the use of artificial intelligence to the extent and as long as they cannot make their procedures and results transparent and comprehensible. Violations of these requirements can result in claims for information and damages against the health or long-term care insurance funds.
02.06.2025
More than half of all German citizens over the age of 14 (55 % and therefore 39 million German citizens) own a smartphone (BITKOM 2014), on which an average of up to 23 application programs (apps) are installed (BITKOM 2012). The popularity shown by these numbers offers – also for statutory health insurance companies (GKVn) – new opportunities for reaching target groups in a wide variety of areas, from primary prevention to diabetes management. But if GKVn want to use apps, for example, to fulfill their legal obligation to provide health information and advice (Section 1 SGB V), they have to take a few things into account in the highly sensitive health market.
24.01.2013
When it comes to health matters, patients are anything but used to taking responsibility for themselves and their health. SGB V already emphasizes that they have shared responsibility and a duty to cooperate. However, it assigns the main responsibility to statutory health insurance. In the past, the traditional way of thinking in medicine often led to patients being seen as objects of medicine without their own responsibility (Schmid et al., page 14). In this context, the focus of care on acute, episodic and one-dimensional diseases is specifically mentioned, not least due to ever-increasing specializations (Müller-Mundt and Schaeffer, page 143).