During the expansion of the private insurance business at the end of the nineteenth century, the practice of medical underwriting in private insurance became a subject of public debate. Since then, the issue has virtually disappeared from the public agenda. Medical risk selection has been accepted as a routine step in the application procedure for private life insurance, while medicine's gatekeeper role in insurance has rarely been criticized. The legitimacy of this practice rests in the scientific medico-actuarial dealing with risks via the development of actuarial science, mortality tables, medical expertise and technologies. The rise of predictive medicine, however, has prompted new debates on the issue of medical selection in private insurance, bringing the relationship between medicine and insurance back into the foreground.

Over the past decade the potential of genetics for understanding health and disease in radically new ways has been widely discussed. Genetic researchers anticipate that it will be possible to test for a variety of susceptibility genes and consider appropriate prevention strategies.