Insurance medicine: From eyeballing to thorough check-up

This is a study of the problematic integration of medical practice in the American insurance industry. The study demonstrates that insurance medicine developed in the insurance industry when the expertise of the medical profession and the techniques of business enterprise were combined. This innovation occurred in the United States when physicians were asked to serve on the board of insurance companies as observers when "the mutuals" were initially organized in the 1840's. The specialty of insurance medicine was the result of improved medical education, the organized professionalization of physicians and the adaptation of the revolutionary medical technology that was invented around the turn of the 20th century. The new scientific inventions were needed, encouraged and financed. This special combination of business and medicine presents a conflict between the goals for business and the service orientation of physicians. This business/medicine relationship is clarified in two case studies. The cases are hypertension and AIDS. The case of hypertension illustrates the systems that evolved in the insurance industry to define and diagnose elevated blood pressure. The systems that emerged demonstrate how functional the insurance medicine health model can be and how insurance medicine specialists fulfilled two functions; saving money and contributing to improved health in the community. The case of AIDS illustrates how the existing insurance medicine health model adapts to address the unclassified disease of AIDS for which there is no treatment. Since AIDS results in earlier deaths it creates greater risks for the insurance industry. The risks are presently addressed with extensive research and policies of exclusion.;The ongoing negotiations and problems analyzed in this study clarify the business/medicine relationship and the systems that emerge. The systems point to the contributions the insurance industry has made to the community by distributing educational materials and sharing technological data. The problems discussed indicate recommendations that can be applied to present health care debates.