A German health insurance company has offered all of its customers a test for a genetic disorder so that they can receive early treatment if they are affected. Four thousand customers took up the offer, and 67 were told that they were at high risk of the disease.

In cooperation with the Hanover Medical School, the Kaufmännische Krankenkasse, a health insurance company with about two million customers, offered all of its clients a test for the hereditary disease haemochromatosis, a disorder in which the body stores too much iron. The results were given exclusively to the people tested and not divulged to the company.

Haemochromatosis is an autosomal recessive disorder, which is characterised by excessive iron absorption in the gut and causes damage to the kidney, liver, and other organs, eventually leading to organ failure. Symptoms usually occur first after the age of 40. The disorder is treated by regular venesection (giving blood) to reduce the amount of iron.

At a press conference to announce the results of the initiative, Ingo Kailuweit, the company chairman, reported that out of almost 4000 voluntary participants, 67 people were identified as homozygous (carrying two copies of the faulty gene) and therefore at high risk of developing the disease. Not all people who carry two faulty genes develop the full blown disease, so some of the 67 people identified as being at high risk may remain healthy.

An opinion poll at the time of testing showed that almost 90% of the population supported genetic testing as part of a health insurance company’s programme if it provided benefit to the participants.

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Commentary:

This shows how genetic testing is being used to reduce a potential financial burden on the insurance company for treating a preventable disease, without compromising the principle that insurance covers individual risk by using contributions from the whole membership without discrimination against risks about which the individual has no control. It costs more to insure a smoker, but continuing to smoke is a choice that is made by the individual.

Since the disease is often detected in its late stages, patients identified as carrying two faulty genes for the disorder at an early stage might be spared dialysis and possible kidney and liver transplantation. The estimated cost of treating someone with the disease when it is discovered late is about €100 000 (£69 000; $130 000).

The German government is passing a law on genetic testing, which will ensure that customers will not have to disclose the results of any genetic tests to life insurance companies if they are insuring their lives for less than €250 000. Nor will they ever have to disclose such results to their employers. The law will also make it compulsory to offer counselling to all people offered genetic tests.

If people were simply told their blood group and counselled on how to act according to that information, it would benefit everyone's health, and not just a tiny minority with rare genetic conditions.

Reference:

BMJ 2004;329:1364