Periodic health examinations - an international comparison

Background: The purpose of periodic health examinations is to prevent disease through early intervention and through stratifying individual patients' health risk. The German health examination as defined in section 25 of the Social Code Book V (Sozialgesetzbuch V) seems to be outdated in many respects. In order to develop an alternative to the current German system an international comparison of periodic health examinations in other healthcare systems is useful. Objective: The study investigates the measures taken for primary prevention of cardiovascular disease in seven countries. Content, implementation and organisation of the various programmes are analysed in the present paper. Methods: The present study was designed as a qualitative multiple case study. The collection of data on cardiovascular screening programmes in the seven different healthcare systems in this study relies on information publicly available on the Internet. The data were entered into a matrix which had been created prior to the data collection and which covers the relevant points of screening. Finally, the data were triangulated using guided telephone interviews with key informants. One general practitioner (GP) was interviewed per country. The measures taken in the respective healthcare systems were then compared and analysed. Results: The measures taken in the countries studied for the primary prevention of cardiovascular disease are heterogeneous. The structures range from guideline recommendations (Castilla y Leon, Switzerland, Norway), and incentive payments for doctors (British Columbia), to opportunistic and population-based programmes (Germany and England, and Group Health in the US). The American health maintenance organisation Group Health offers an established, evidence-based programme whereas the German health examination dates back to a time when evidence-based medicine was not yet established and is therefore relatively outdated. Discussion: Despite scientific evidence of primary prevention of cardiovascular disease, evidence-based measures cannot be found in all the healthcare systems analysed. The paper discusses sociocultural and political aspects as influencing factors on prevention programmes.