Impact of Genetic Testing on Surveillance and Prevention

There is a prospect of substantial advancements in the understanding of the relationship between disease and genetics at least in the medium term to long term future. In this paper we consider the implications on two aspects of behaviour - surveillance to improve the chances of early detection of disease onset and preventive actions to reduce the probability of onset - that may change as a result of the acquisition of information from genetic tests. We argue that there are problems for both private insurance regimes, with risk-rating allowed according to genetic type, and public insurance regimes (or a private insurance system with an "effective" community rating regulation) in generating potential health benefits from increased genetic information. In the public regime appropriate signals to obtain genetic information are not always provided while in the private regime premium risk can block otherwise fruitful acquisitions of this information. In both regimes moral hazard considerations can blunt the adoption of otherwise useful information with the further problem for public insurance of possibly encouraging excessive adoption of genetic testing.