Health: Kasse now pays for a trisomy test in pregnant women – knowledge

Blood tests, which promise to find out about certain genetic defects in the baby, will pay for health insurance in certain cases from Friday. Photo: Tobias Kleinschmidt / dpa


As of Friday, the time has come: health insurance pays for prenatal blood tests for trisomies. What led to this decision – and why it continues to give headaches to associations and doctors.

Berlin (dpa) – For many future parents, the health of the baby is the most important thing – and with that, anxiety during pregnancy is great.

Blood tests, which promise to find out about certain genetic defects in the baby, will in certain cases be paid by health insurance from Friday (July 1). However, what might seem like a victory to many is causing disability associations, many churches and doctors to sound the alarm: the topic has been debated, sometimes vigorously, for years. Experts still see frequent blood tests for trisomy 21 as a thin line – and often as an ethical trap.

The so-called non-invasive prenatal tests (NIPT) have been available to women since 2012, but so far they have usually had to pay for themselves, which can be expensive. During the test, the blood sample of the future mother is examined for certain genetic defects in the fetus: for example, trisomy 21 (Down syndrome), in which chromosome 21 is present three times and which is associated with different degrees of physical and mental abnormality.

If the test is negative, it can be ruled out with a high probability that the unborn child has trisomy 21. If, on the other hand, it is conspicuous, another intervention must follow to make a reliable diagnosis – such as an amniotic fluid test, which is associated with a low risk of miscarriage.

Risk-free blood test

The Joint Federal Committee (G-BA), a body that brings together doctors, health insurance companies and clinics, has already basically decided in 2019 that NIPT should be applied to trisomies 21, 13 and 18 in justified individual cases and following medical advice using information for insured persons of compulsory health insurance (GKV). One argument: Unlike older methods, a blood test is risk-free for both mother and child.



Berlin (dpa) – For many future parents, the health of the baby is the most important thing – and with that, anxiety during pregnancy is great.

Blood tests, which promise to find out about certain genetic defects in the baby, will in certain cases be paid by health insurance from Friday (July 1). However, what might seem like a victory to many is causing disability associations, many churches and doctors to sound the alarm: the topic has been debated, sometimes vigorously, for years. Experts still see frequent blood tests for trisomy 21 as a thin line – and often as an ethical trap.

The so-called non-invasive prenatal tests (NIPT) have been available to women since 2012, but so far they have usually had to pay for themselves, which can be expensive. During the test, the blood sample of the future mother is examined for certain genetic defects in the fetus: for example, trisomy 21 (Down syndrome), in which chromosome 21 is present three times and which is associated with different degrees of physical and mental abnormality.

If the test is negative, it can be ruled out with a high probability that the unborn child has trisomy 21. If, on the other hand, it is conspicuous, another intervention must follow to make a reliable diagnosis – such as an amniotic fluid test, which is associated with a low risk of miscarriage.

Risk-free blood test

The Joint Federal Committee (G-BA), a body that brings together doctors, health insurance companies and clinics, has already basically decided in 2019 that NIPT should be applied to trisomies 21, 13 and 18 in justified individual cases and following medical advice using information for insured persons of compulsory health insurance (GKV). One argument: Unlike older methods, a blood test is risk-free for both mother and child.

The General Association of the Disabled in Germany (ABiD) now warns of a “large selection”. Social counselor Dennis Riehle recently said he thinks it is “incompatible with applicable social security laws for health insurance to fund blood tests for trisomy 21 in the future”. Pushing increases the incentive for genetic diagnostics to be carried out as a standard – a trend that must be prevented.

“The utopian ideology of the ideal man would find more followers. We must not allow any selection, but we must put the protection of each individual at the center of our thoughts and actions,” Riehle said. After all, any incentive to learn about a disability such as Down syndrome in a growing baby is “a potential help in making decisions to position one-sidedly and uncritically toward the child”.

screening should be prevented

Thomas von Ostrowski, a board member of the Professional Association of Prenatal Doctors (BVNP), sees the problem in the vague definition of who should be paid for the tests. In an interview with dpa, he also warns: “Under no circumstances should the NIPT be understood as a screening test for trisomy 21.” From his point of view, this could happen given the unclear specifications. The G-BA decision stipulates that the new FCH benefit will take effect if other tests indicate trisomy – or if the woman and her doctor are convinced that the test is necessary in her personal situation.

Angelika Wolff, an expert in counseling for pregnant women and pregnancy conflicts in Diakonia Germany, said when asked: “We expect that the implementation of the NIPT could become widespread.” The regulation refers to the assumption of costs in the case of “high-risk pregnancy” – but this is not a clearly defined term.

A spokeswoman for the committee stressed that G-BA had never made the decision easier for itself. In addition to the main argument that the test is a safe alternative to invasive examinations, the fact that including a blood test in statutory health insurance will end the imbalance also plays an important role. So far, the question of financial resources has been whether women can use the test or are dependent on invasive procedures.

A striking result requires further clarification

Experts see the key – but also the biggest difficulty – in communication and information. A G-BA spokesperson referred to a brochure for insured persons, which must be included in the consultation. This describes which statements are possible with a blood test and which are not and how reliable the test results are. In addition, the striking result must first be further clarified.

Von Ostrowski says, “The central challenge will be to talk to a pregnant woman to allow her to make her own decision.” From his point of view, however, the information for the insured is contradictory and leaves questions unanswered. Doctors now have a huge responsibility. Wolff of Diakonia also emphasizes the great importance of psychosocial counseling in difficult decision-making processes – and sees the increased need for networked collaboration between different disciplines.

But with the new regulations, future mothers (and fathers) and society as a whole will also have to face many things. BVNP board member von Ostrowksi is confident: “The expansion of the NIPT as a health insurance service will further contribute to polarization in society.”

Riehle even sees a “social explosive effect” in the new regulation. However, he believes that the focus of the social debate is wrong: instead of discussing prenatal diagnosis, there should be a debate about the image of disability. “Recognizing the full dignity of each person remains the task of all of us.” Wolff of Diakonia also stresses that the goal must be to enable all children, including those with trisomy, to grow up well. “Many steps still need to be taken towards a more inclusive society.”

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