[To what extent can the publicly sponsored health system afford predictive genetic diagnostics?--first approaches to pinpoint and limit responsibilities, exemplified by hereditary carcinomas].
Present predictive genetic tests for widespread multicausal and chronic conditions such as carcinoma and in the near future heart diseases and neurodegenerative conditions, urge their way into the health care system. In health care a change of the paradigm takes place: from caring for sick individuals to counselling and taking care of healthy persons and families burdened by a hereditary disposition. Essential for health care services is the question of actual advantage of the genetic tests for individuals, families as well as for society, and closely associated with the medical consequences of the tests. Decision makers in the financing of health care services are faced by the challenge to create a generally valid regulatory framework applicable for inclusion or refusal of present and future genetic tests by public health care services. Of relevance for those decisions are the questions whether the genetic tests make a difference in the impediment and primary prevention of disease, and the possibilities for successful early treatment.
Wild
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C
Osterreichische Akademie der Wissenschaften, Institut für Technikfolgen-Abschätzung, Arbeitsbereich Health Technology Assessment, Vienna, Austria. cwild@oeaw.ac.at
Jonas
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S
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D005260:Female; D019398:Genes, BRCA1; D005817:Genetic Counseling; D030342:Genetic Diseases, Inborn / Q000235:genetics* / Q000517:prevention & control; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000191:economics / Q000941:ethics / Q000331:legislation & jurisprudence; D005838:Genotype; D005858:Germany; D006296:Health Services / Q000191:economics; D006801:Humans; D008297:Male; D008408:Mastectomy; D008875:Middle Aged; D009154:Mutation; D010052:Ovariectomy; D010641:Phenotype; D011322:Primary Prevention