First statutory health insurance company pays for urine tests to prevent cancer

First of all, there are the numbers, they sound frightening: 40 percent of the population in Germany suffer from one chronic illness. 30 percent live with it for 20 years or longer. You will never fully recover and will need regular medical care. The healthcare system in this country spends almost 114 billion euros per year on this, around 26 percent of the total budget of 432 billion.

Then there is a procedure that can be used to detect a number of diseases at an early stage before they become chronic. The method is called proteome analysis, and in simple terms it works like this: blood or urine are examined for proteins. About 25,000 of these molecules are known. If they show changes, conclusions can be drawn about health.

And then there is Ralf Hermes, chairman of a statutory health insurance company with around 300,000 members, the IK Innovationskasse. He has recently started offering his customers proteome analysis using urine. A laboratory examines the samples. The insurance covers 500 of the total 850 euros for a test. This makes it the first to include the procedure in its catalog of services. “This form of prevention seems to have the potential to solve a large part of the cost problem in the health system,” says Hermes.

This very system is facing a difficult situation – financially and in terms of personnel. It will continue to worsen if viable solutions to the problems of the future are not found. Fewer and fewer people need to provide medical care to more and more people. There is already a lack of skilled personnel. The baby boomers are now gradually retiring. At some point you will have to take care of yourself.

Health insurance boss wants to move away from “repair medicine”

“We therefore need a paradigm shift to move away from repair medicine,” says Ralf Hermes. The goal must be prevention rather than cure. The realization is becoming increasingly widespread: improved prevention means that treatment can be individually tailored to each patient. “We can then also administer personalized medication. This guarantees greater accuracy,” says Hermes.

This is where proteins come into play – and Harald Mischak. His research focus is the analysis of proteomes. The professor founded a biotech company for the early detection of diseases. Mischak says: “Proteins are the class of molecules responsible for life. They are also the target structure for every drug.”

In turn, diseases of the cardiovascular system, kidneys or some types of tumors, especially prostate and bladder carcinomas, can be detected in the urine. “Usually, urine contains around 4,000 to 5,000 different proteins,” says Mischak. During an illness, some of these molecules change, they become damaged, there are too many or too few of them. “In chronic kidney disease, there are 173 proteins that can show abnormalities,” says Mischak.

If they are discovered early enough, countermeasures can be taken. Medication does not always have to be used for this. Sometimes just a change in lifestyle, a better diet, and more exercise can help. “Based on the proteome analysis, I can tell the patient which intervention is likely to bring the best success before he or she suffers irreversible organ damage,” says Mischak.

His company specializes in urine analysis. “This method has advantages: urine can be obtained more easily. It is very stable, the proteins remain unchanged over a relatively long period of time.” The samples do not have to be examined where they were taken. They can be safely packaged and shipped.

“Most of the so-called widespread diseases in Germany can be detected with a certainty of 85 to 90 percent,” says Ralf Hermes. He offers urine tests to his customers if there are risk factors: high blood pressure or being very overweight. “We focus on diseases where proteomic analysis is very precise, affecting the cardiovascular system, kidneys and prostate.”

The insured can approach the cash register themselves or will be contacted. “We use our billing data to identify people with a specific risk profile. If they are not interested in testing, the matter is over.”

Hermes is considered a controversial spirit in his industry. For example, he recently suggested drastically reducing the number of statutory health insurance companies from the current 95. And with his push for prevention he also wants to at least initiate a debate. “I was wondering why proteome analysis is not included in the statutory catalog of services,” says Hermes. He says: “Everyone has settled into the system and come to terms with it: especially with the health fund and the distribution of the money.”

Are insurance companies worried about their financial allocations?

All contributions from the insured and contributions from the state are paid into the health fund. The financial equalization regulates how the money is distributed among the statutory funds. It is intended to compensate for differences in income and illnesses among the insured. “The big players, the so-called utility funds, have no interest in losing these allocations,” says Hermes. “And then I think of parts of the medical profession and the pharmaceutical industry who live well with the status quo.”

Before prevention saves money, it first requires investment. “If in doubt, it will pay off years later, but it will pay off,” says Hermes. “In any case, Health Minister Karl Lauterbach’s hospital reform does not solve the problem. This means we have no fewer fates, no fewer costs.”