Digital Patient Assistants

Many countries have a compulsory health insurance system in place. Compulsory health insurers charge income related fees as opposed to private health insurers who charge risk related fees. Compulsory health insurance is based on solidarity among policy holders and can give them more privacy than any private health insurer can. As an example, we consider the German health insurance system, and we discuss how the charging and clearing of medical services can be implemented so as to support both the legitimate privacy interests of patients and physicians and the health insurer’s interest to control the overall cost. We present a cryptographic solution that is based on digital patient assistants, i.e., personal palmtop computers, organizers or PDAs. Patients are thus able to manage their own health insurance certificates, referrals and prescriptions. Although still too expensive for large scale introduction, digital patient assistants have a number of significant advantages over any chip-card or paper based system: (i) significantly more efficient and reliable data communication between the various health care providers involved in treatment; (ii) real patient privacy through direct and offline communication between digital patient assistants and physicians’ practices; (iii) a huge potential to develop telemedicine in a privacy oriented way. Finally we present one possible implementation in more detail. We also show how compulsory health insurers can use our solution to control their overall costs.