Prevention
Promoting health and preventing disease: these are the overarching goals of prevention measures. In particular, they strengthen health literacy and enable people to make their own health decisions. In digital prevention services, digital technologies take over all or some of the tasks of therapists and trainers.
The German Digital Healthcare Association (SVDGV) advocates a prevention-oriented paradigm shift in the German healthcare system, which has so far focused on treating diseases. Instead, the focus of care should shift to promoting a healthy lifestyle and thus to preventing diseases.
- Examples of digital prevention services include internet-based health information and training as well as smartphone apps that support health-promoting behaviour.
- Under certain conditions, the costs of digital prevention services are covered in full or in part by the statutory health insurers.
- Digital prevention services differ from DiGA (digital health applications) in terms of their objectives and regulatory framework, among other things.
- Key advantages of digital prevention services are that they can be used flexibly, regardless of time and place, and that they are scalable.
What are digital prevention services?
In digital prevention and health promotion services, digital technologies take over tasks that people perform in conventional prevention programmes. In principle, digital prevention measures pursue the same goals as traditional, non-digital prevention programmes:
- Promoting health
- Preventing diseases and accidents
- Slowing down or preventing the deterioration (progression) of an existing disease
Various digital technologies can be used individually or in combination. Examples include:
- Internet-based information and programmes
- Smartphone apps
- Voice assistants
- Wearables
Digital prevention services can also be used as part of workplace health management or rehabilitation measures (secondary prevention).
In a broader sense, medical lifestyle technologies such as fitness trackers or self-tracking apps (quantified self) can also be counted as digital prevention.
Examples of digital prevention services
The wide range of digital prevention services can be distinguished by the following criteria, among others:
By "digital share"
- In purely digital prevention measures, all interventions are delivered using digital technologies, for example via smartphone apps, online training or wearables.
- Hybrid prevention services combine digital and non-digital interventions in the sense of "blended learning", for example a smartphone app for heart health that supports participants in a cardiac exercise group.
By prevention setting
- Behavioural prevention: Digital solutions can support individual behaviour change, for example with regard to diet, physical activity, stress management or addictive behaviour.
- Structural prevention: Digital technologies can have a positive influence on the adverse living conditions of individuals or groups, for example older people and disadvantaged groups such as homeless people.
There are also prevention services that combine both of these forms.
By target group
- For individuals or groups with specific risk factors or an existing disease: these services include smartphone apps for weight loss in obesity or online training programmes for people with diabetes.
- For the general population or larger population groups: examples include websites providing information on infectious diseases or the Corona-Warn-App
Who covers the costs of digital prevention services?
Under Section 20(4) SGB V, the statutory health insurers cover the costs of digital prevention services in full or in part under certain conditions. The prerequisite is certification by the Central Prevention Testing Office (Zentrale Prüfstelle Prävention) of the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) in accordance with the "Prevention Guideline (Leitfaden Prävention), Chapter 7". To be certified, services must meet certain requirements, for example:
- The health benefit of the digital prevention service must be demonstrated in a scientific study with endpoints related to the relevant field of action or prevention principle.
- The concept and content of the prevention service must meet certain quality standards.
- Digital prevention services must address one of four fields of action: physical activity, diet, stress and resource management, and consumption of addictive substances.
How do digital prevention services differ from DiGA?
Digital prevention services under Section 20(4) SGB V differ significantly from digital health applications (DiGA) under Section 33a SGB V.
| Digital prevention services | Digital health applications (DiGA) | |
|---|---|---|
| Legal basis | Section 20(4) SGB V | Section 33a SGB V |
| Objective |
Exclusively the prevention of diseases ☑ There does not need to be a medical indication. |
Detection, monitoring, treatment or alleviation of diseases, or detection, treatment, alleviation or compensation of injuries or disabilities ☑ There must be a medical indication. |
| Regulatory requirement | The digital technologies used do not have to be medical devices. | Digital technologies must be certified as medical devices in risk class I, IIa or IIb. |
| "Approval" | By the Central Prevention Testing Office of the GKV-Spitzenverband | By the Federal Institute for Drugs and Medical Devices (BfArM) |
| Cost coverage by statutory health insurers | Variable: insured persons often pay a co-payment | 100% if prescribed by a doctor |
Opportunities of digital prevention
Compared with traditional, non-digital interventions, digital prevention services have a number of advantages:
- Low-threshold access: Users can start digital interventions immediately, without waiting times or organisational hurdles. In addition, some people who avoid conventional programmes for fear of stigmatisation may find it easier to use digital prevention services.
- Flexible, independent of time and place: Digital prevention services are available anytime, anywhere. This means that people with limited mobility, in structurally weak regions or with little time can also easily integrate prevention measures into their daily routine.
- Scalable: In principle, any number of people can take part in digital prevention services. They do not depend on available premises or on therapists or trainers.
- Customisable: Digital prevention services can be tailored to the needs of individual users, for example with different modules or versions.
Obstacles to the use of digital prevention services
The use of digital prevention services faces similar obstacles to traditional prevention programmes:
- Prevention is given low priority in the current German healthcare system. Only 3.5% of health expenditure goes to prevention and early detection. There is also no overarching strategy for prevention and health promotion.
- For many prevention services, insured persons first have to pay in advance before the statutory health insurers reimburse (part of) the costs.
- Due to a lack of information, many insured persons are not aware of the prevention services available.
Outlook: the future of digital prevention services
For (digital) prevention services to develop further, it is important that the focus of the healthcare system shifts from today's "repair medicine" towards preventive medicine. Hybrid prevention models in which digital and non-digital interventions complement each other could play an increasingly important role. Finally, artificial intelligence (AI) offers new ways of identifying individual health risks at an early stage and initiating appropriate preventive measures.
Answers to frequently asked questions about digital prevention services
What are digital prevention services?
Like conventional prevention programmes, digital prevention services aim to promote health and prevent disease. In these services, digital technologies take over tasks that people (for example course instructors) perform in traditional prevention.
What are examples of digital prevention services?
Digital prevention services include, for example, health education websites, smartphone apps for weight loss or for promoting physical activity, online training programmes for people with certain chronic diseases, and wearables such as fitness trackers.
How do DiGA differ from digital prevention services?
- Digital prevention services under Section 20(4) SGB V are aimed at people who do not need treatment (no medical indication). The aim is to prevent diseases. Under certain conditions, the statutory health insurers can reimburse the costs of digital prevention services in full or in part.
- By contrast, doctors and psychotherapists can prescribe DiGA under Section 33a SGB V only to people with a specific medical indication (disease). The statutory health insurers then cover 100% of the costs of a prescribed DiGA.
There are also further differences regarding the "approval" of digital prevention services and DiGA.
What are the benefits of digital prevention services?
Digital prevention programmes offer low-threshold access to health promotion. They are available to many people regardless of time and place and independently of staff resources.
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