[Screening of insurance applicants: experience in international insurance medicine]

Following a brief historical look at international developments in medical examinations of life insurance applicants, the paper goes on to examine the criteria used today for screening in clinical medicine. There are great similarities between the main reasons for screening in clinical medicine and insurance medicine. On the one hand, there is the need to detect a disease early in its history. On the other, the need to identify risk factors. The procedures used by life insurers are also described. The USA is taken as an example to show the direction that international developments are taking. Future aspects are considered with particular regard to future availability of genetic tests. An insurance medical discussion on genetic tests is followed by a description of the debate on the ethics of biotechnology in the Council of Europe and European Parliament. A conceivable scenario is developed which assumes the future availability of genetic test results in doctors' surgeries. The decisive factor here is that the insurer continues to have full knowledge of the applicant's state of health at the time of application. Only by this way can antiselection be avoided. This is followed by a detailed representation of the responsibility that insurance medicine and insurers have in connection with screening modalities. Genetic tests are not used by insurers today. There exists a kind of wait-and-see attitude which amounts to something like a moratorium. The time until further decisions are made should be used to gather further scientific findings and also to correct possible misconceptions at all relevant levels.