WHO PAYS FOR GENOME SEQUENCING IN PREVENTIVE MEDICINE?
One might think that healthcare providers or insurance companies should pay people to have their genome sequenced while they are healthy—with this information, such individuals are likely to manage their health better. Presently, however, healthy people pay for their own genome sequencing; only in rare exceptions can it be justified as a potential cost savings. In the United States, there is no incentive from the payers’ (insurers) perspective to pay for such sequencing even if it results in an overall costs savings in the long-term. One major reason is that individuals in the United States usually obtain their insurance through their employer. Because the individual can change jobs or the employer can change health plans, it may not benefit one insurance company to invest large sums of money to prevent future disease when the insured individual may not be with their plan in the future.
Preventative healthcare genome sequencing is gaining much more traction in places with socialized medicine, notably Canada, Europe, and Japan. Already large projects such as the 100K UK project and others are being launched to test the role of incorporating genome sequencing into health care. The Million Veterans projects (MVP) in the United States and the recently announced Precision Medicine Initiative have the potential to accomplish this as well. These projects will be valuable in testing whether health care quality, outcome, and costs will benefit from genome sequencing technology. It is also possible that healthcare providers can partner with pharmaceutical companies; in exchange for covering the sequencing costs companies can gain access to medical information that can help develop new drug targets or applications of existing drugs. A partnership of this type has been established between the Geisinger Health System and the Regeneron pharmaceutical company, in which over 100,000 individuals will be sequenced.
Until genome sequencing and other omics technologies become widely implemented, medicine will remain a much more reactive profession in many respects—one in which people largely seek medical advice after a disease arises rather than a preventative profession where information is used to guide lifestyle and help early diagnosis.