The ethics of behaviour-based insurance models: Solidarity-based concerns in Germany's statutory health insurance

Sickness funds have begun to harness digital behavioural data to incentivise physical activity in their members. This ethical and societal effects of this phenomenon remain largely unclear, especially in solidarity-based insurance systems. Therefore, this study analysed the risks and benefits of such programmes with respect to solidarity against the background of recent efforts by German statutory health insurance funds to integrate digital tracking data into their bonus programmes. Key, potential benefits include new forms of solidarity that may emerge based on sharing personal health data. The incentives introduced by these reward programmes could lead to efficiency gains used to benefit society. However, three conceptual pitfalls have been identified: First, the data gathering method may penalise certain vulnerable groups. Such discrimination could, however, be avoided by minimising barriers to participation. Second, digitally mediated bonus programmes may create deadweight effects, i.e. beneficiaries are likely to already be healthy and active. Consequently, behavioural targets should be designed to consider individual prerequisites. Lastly, linking premiums to behaviour might diminish solidarity with poor risks within statutory health insurances and between statutory and private health insurance. Hence, this study aimed to stimulate debate on the ethical and societal implications of the systemic integration of eHealth innovations into healthcare systems.