Alami Hassane, Rivard Lysanne, de Oliveira Robson Rocha, Lehoux Pascale, Cadeddu Stéphanie Bernadette Mafalda, Savoldelli Mathilde, Ag Ahmed Mohamed Ali, Fortin Jean-Paul
Center for Public Health Research, Université de Montréal, Montreal, QC, Canada.
Department of Health Management, Evaluation, and Policy, Université de Montréal, Montreal, QC, Canada.
J Particip Med. 2020 Aug 21;12(3):e19586. doi: 10.2196/19586.
While the transition toward digitalized health care and service delivery challenges many publicly and privately funded health systems, patients are already producing a phenomenal amount of data on their health and lifestyle through their personal use of mobile technologies. To extract value from such user-generated data, a new insurance model is emerging called Pay-As-You-Live (PAYL). This model differs from other insurance models by offering to support clients in the management of their health in a more interactive yet directive manner. Despite significant promises for clients, there are critical issues that remain unaddressed, especially as PAYL models can significantly disrupt current collective insurance models and question the social contract in so-called universal and public health systems. In this paper, we discuss the following issues of concern: the quantification of health-related behavior, the burden of proof of compliance, client data privacy, and the potential threat to health insurance models based on risk mutualization. We explore how more responsible health insurance models in the digital health era could be developed, particularly by drawing from the Responsible Innovation in Health framework.
虽然向数字化医疗保健和服务提供的转变给许多公共和私人资助的医疗系统带来了挑战，但患者通过个人使用移动技术已经在产生大量关于其健康和生活方式的数据。为了从这些用户生成的数据中提取价值，一种名为“按生活付费”（PAYL）的新保险模式正在兴起。这种模式与其他保险模式的不同之处在于，它以更具互动性但又具有指导性的方式为客户提供健康管理方面的支持。尽管对客户有重大承诺，但仍有一些关键问题未得到解决，特别是因为PAYL模式可能会严重扰乱当前的集体保险模式，并对所谓的全民和公共医疗系统中的社会契约提出质疑。在本文中，我们讨论以下关注问题：与健康相关行为的量化、合规的举证责任、客户数据隐私以及基于风险共担的医疗保险模式面临的潜在威胁。我们探讨如何在数字健康时代开发更具责任感的医疗保险模式，特别是借鉴健康领域的负责任创新框架。
