[Insurance and preventive medicine].

Area of Science:

• Occupational Health
• Public Health Policy
• Preventive Medicine

Context:

• The Swiss National Accident Insurance Fund (CNA) is legally mandated to prevent work-related accidents and occupational diseases.
• Preventive medicine in general health insurance programs has seen limited success due to legislative barriers.
• A key difference lies in the controllability of causal factors: exogenous for accidents/diseases versus endogenous for general population pathologies.

Purpose:

• To explore the disparity in insurance coverage and focus between occupational accident/disease prevention and general preventive medicine.
• To identify reasons for the legislative denial of payment for preventive medical care in sickness insurance.
• To assess the potential for integrating scientifically validated preventive examinations into insurance programs.

Summary:

• Occupational accident and disease prevention is a legal requirement and shows promise, unlike general preventive medicine which is not legislatively covered.
• The difference in success is attributed to the more controllable, exogenous factors in occupational settings compared to the complex, endogenous factors in general health.
• Selected, evidence-based preventive screenings could be incorporated into insurance plans with stringent quality assurance.

Impact:

• Highlights the need for legislative reform to support preventive healthcare in the general population.
• Suggests a framework for incorporating validated preventive measures into insurance, potentially improving long-term health outcomes.
• Underscores the importance of quality control in laboratory diagnostics for effective preventive care programs.