Article from the series “Perspectives on Personalized Health”
In previous articles in this series, we have discussed the importance of evolving the current healthcare system—based on treating disease—towards more proactive models of health management. This need, beyond being positive for the well-being of the population as a whole, would lead to better use of available healthcare resources and allow us to move toward a more modern and sustainable healthcare model. But is this possible? Can we afford a personalized health model in Spain?
A top-tier National Health System
The National Health System (SNS) is undoubtedly one of Spain’s crown jewels. Universal access to an essential pillar of a welfare society, together with a strong network of top-level biomedical research centers, places us at the forefront of Europe (and the world) in areas such as organ donation and transplantation, clinical trials, and life expectancy.
However, these achievements are weighed down by structural deficits in staffing, uncompetitive salaries for healthcare professionals, and long waiting lists for users. Added to these issues is another major obstacle that hinders the application of genetic or molecular personalized medicine techniques: Spain is the only country in the European Union without a medical specialty in Clinical Genetics. This does not mean that there are no excellent professionals in this field in our country, but there are certainly not enough of them, nor do they have sufficient recognition or training opportunities.
The complementary role of private healthcare
On the other hand, private healthcare plays a significant role, accounting for 30% of healthcare spending in Spain and representing, for many people, a complement to the SNS that allows faster access to specialists of equal prestige, greater comfort during hospitalization, and, in general, access to coverage that the SNS cannot provide due to its universal nature.
Until recently, the coverage and approach of insurers or health mutuals did not differ greatly from what the SNS offers. However, in recent years we have seen insurers expand their portfolios with telemedicine services, health monitoring applications, and a growing range of high value-added tests for users.
Genetics and insurance
Traditionally, an insurer or health mutual distributes the risk of its users, transforming a high, occasional, individual expense into an affordable, recurring, collective model. The role of actuaries in insurance companies is well known: they calculate risk probabilities and coverage using statistical and mathematical models to ensure the numbers add up.
At this point, we can revisit one of the concepts discussed in the first chapter of this series: the management of risk and uncertainty, which applies both to actuarial calculations and to the impact that certain genetic conditions may have on our health. Would it make sense, then, to incorporate certain genetic variables into risk calculations in order to make more accurate predictions?
The answer is no. Health insurance is founded on the dilution of risk among its insured members. Just as no one would randomly bet on a roulette wheel that we know is biased toward a particular number, insurance companies and health mutuals cannot discriminate against users for genetic reasons. In fact, there are specific laws in most countries that prohibit this. Moreover, insurance companies cannot access their users’ health information, whether genetic or any other type generated within the healthcare system. Does this mean that health mutuals have nothing to say about transforming the healthcare model? On the contrary—they are a fundamental piece.
From risk management to health management
As we have seen, insurers and mutuals complement the SNS by offering additional services or a better user experience, and they share a very relevant interest with their users: taking the best possible care of their present and future health. As discussed in the previous article in this series, caring for health is not the same as treating disease. Models and policies based on health promotion are beneficial both for user well-being and for the economic sustainability of the system.
For this very reason, private healthcare providers have the opportunity to play a role that is currently beyond the reach of public healthcare: leading the transition from a reactive medical model—based on caring for and treating disease—toward a preventive and participatory health model, in which users themselves become involved and understand the need to care for their health on an individual basis.
