- Legal clarification in the KVG that profiling and automated individual decisions are permitted for the fulfillment of tasks in order to ensure legal certainty.
- Health insurers need automated, cross-invoice data analysis to identify systematic irregularities and control costs.
- Avoid incongruence with UVG: Profiling should also be enshrined in the KVG so that accident and health insurers have the same powers of review.
Submitted text
The Federal Council is instructed to adopt the following amendment to the Federal Health Insurance Act (KVG) to be submitted: For the statutory responsibility To ensure effective, appropriate and economical medical treatment, health insurers should – while maintaining personal data protection – collect the data of their insured persons. continue to evaluate as well as issue automated individual decisions may
Justification
Due to European data protection legislation and the current total revision of the Federal Data Protection Act (FADP), various other laws of the new term “profiling” and the enactment of automated individual decisions be anchored in the law. The KVG is also affected: For the statutory task of ensuring effective, expedient and economical medical treatment, health insurers are to continue to be allowed to evaluate the data of their insured persons – while maintaining personal data protection – and to issue automated individual decisions.
Current is in Article 84 KVG regulates the processing of personal data – including the processing of data requiring special protection and personality profiles. As part of the total revision of the FADP, it is now necessary to the term “profiling” is also anchored in the KVG. must be made. Otherwise, there is a risk of legal uncertainty in the future implementation of the statutory tasks.
More than 120 million invoices per year cannot be evaluated and correlated by hand, e.g., to identify systematic billing irregularities. Health insurers must be in a position to use EDP-based systems to cross-accounting checks to be carried out. This is not possible without machine or automated processing of personal data.
Moreover, it is not comprehensible why in the Federal Law on Accident Insurance (UVG) the implementation of Profilings is to be enshrined in law, but not in the KVG. Both accident and health insurers must verify by law that medical treatments are appropriate and economical (Art. 48 and 54a UVG and Art. 32 and 56 KVG).
The group of experts on the cost containment report, the Federal Council and politicians are calling on health insurers to tighter cost control. In order for health insurers to be able to fulfill this obligation, a clear and unambiguous legal regulation is needed.