Prevention for those who can pay: insurance reimbursement of genetic-based preventive interventions in the liminal state between health and disease
Prevention for those who can pay: insurance reimbursement of genetic-based preventive interventions in the liminal state between health and disease
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DOI：
10.1093/jlb/lsv008
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发表时间：
2015-07-01
影响因子：
3.4
通讯作者：
Prince, Anya E. R.
中科院分区：
文献类型：
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作者：
Prince, Anya E. R.
临床使用基因检测来预测成人发病条件允许个人尽量减少或规避疾病时，预防性医疗干预措施是可用的。最近的政策建议和变化扩大了患者获得无症状遗传病信息的机会，并建立了扩大基因检测保险覆盖范围的机制。美国医学遗传学和基因组学学院（ACMG）建议实验室在全基因组测序后提供医学上可操作的遗传变异的偶然发现。《患者保护和平价医疗法案》（ACA）建立了强制覆盖BRCA等基因检测的机制。然而，《儿童保护法》和《儿童保护法》并不涉及预防性干预措施的保险范围。这些政策将获得检测等同于获得预防，而没有探讨干预措施的可获得性和可负担性。事实上，鉴于美国医疗保险系统对治疗的关注，无症状成年人预防干预的保险覆盖范围是可变的。如果只有社会特权阶层才能获得预防性干预措施，如预防性手术、筛查或药物治疗，健康差距将加剧。为了确保公平获得干预措施，联邦或州立法机构应强制规定，为预测性基因检测和专家小组或监管机构制定的清单中所列的建议后续干预措施提供保险。
Clinical use of genetic testing to predict adult onset conditions allows individuals to minimize or circumvent disease when preventive medical interventions are available. Recent policy recommendations and changes expand patient access to information about asymptomatic genetic conditions and create mechanisms for expanded insurance coverage for genetic tests. The American College of Medical Genetics and Genomics (ACMG) recommends that laboratories provide incidental findings of medically actionable genetic variants after whole genome sequencing. The Patient Protection and Affordable Care Act (ACA) established mechanisms to mandate coverage for genetic tests, such as BRCA. The ACA and ACMG, however, do not address insurance coverage for preventive interventions. These policies equate access to testing as access to prevention, without exploring the accessibility and affordability of interventions. In reality, insurance coverage for preventive interventions in asymptomatic adults is variable given the US health insurance system's focus on treatment. Health disparities will be exacerbated if only privileged segments of society can access preventive interventions, such as prophylactic surgeries, screenings, or medication. To ensure equitable access to interventions, federal or state legislatures should mandate insurance coverage for both predictive genetic testing and recommended follow-up interventions included in a list established by an expert panel or regulatory body.