Gesundheits- und Früherkennungsuntersuchungen im internationalen Vergleich

Cardiovascular disease and cervical and breast cancer account worldwide for a large burden of disease but can be reduced through periodic screening. Many countries have implemented measures such as the Gesundheitsuntersuchung (check-up 35) in Germany. The present study examines how different health systems implement, structure, and organise periodic health examinations. The health systems of Germany, Norway, Spain, England, Canada, Switzerland and the United States were compared in this respect. The data were collected by means of internet research and were then triangulated with the information obtained from key informant interviews which were conducted with practicing family physicians. Cardiovascular disease prevention is organised differently in the countries analysed. The structures vary from guideline recommendations (Castilla y León, Switzerland, Norway) and financial incentives for doctors (British Columbia) to opportunistic and population-based screening programs (Germany and England and Group Health, USA, respectively). The American health maintenance organisation Group Health offers long-standing, evidence-based measures, whereas the German Gesundheitsuntersuchung dates back to a time when the question of evidence had not yet been posed and is therefore relatively outdated. In contrast to cardiovascular disease prevention, cervical cancer screening developed in a comparatively similar way and is considered relevant in all countries analysed. The pap-test is the most widely used screening test with the screening intervals ranging from two to three years. Germany is the only country offering yearly screening. Cervical screening is performed by general practitioners or other health professionals (practice nurses, midwives) in almost all countries. Screening is opportunistic in Germany, Spain and Switzerland. The other countries switched to population-based screening services in the last few decades. In the majority of countries the same institutions are responsible for organising cervical and breast cancer screening. The structures for breast cancer screening are comparatively uniform. Most of the countries examined offer mammography every two years in specialised facilities, only in England the screening interval is three years. In most countries the women screened are between 50 and 70 years old, or between 40 and 79 in the case of British Columbia. In all countries women receive a written invitation for screening. A clear relationship between health system features and the organisation of screening could not be found. Possible influencing factors such as socio-cultural and political aspects were discussed. Despite differences in the organisation of periodic screening, it seems indispensable in all the countries analysed to implement updating processes, structures for quality assurance, and on-going programme evaluation to ensure a responsible use of health care resources.