Abstracts by keywords: 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
Healthcare innovations aim to make healthcare better and/or more economical. Important starting points and components (without claiming to be exhaustive) are in particular: process optimization with a view to the entire treatment chain, the development of incentive mechanisms for prevention, remuneration models with a focus on the quality of results and not on the quantity and number of services, and active patient participation.