Screening in Austria - The cases of mammography, PSA testing, and routine use of ultrasound in pregnancy

Objective: To study cases of screening in Austria to learn about national s trategies to handle the health policy challenge of early detection of wides pread diseases and about the outcome of those strategies. The article descr ibes three healthcare interventions (mammography, PSA testing, and routine use of ultrasound in pregnancy) and the instruments of Austrian health poli cy that are used-with or without explicit intention-to enforce or to contro l the widespread use of (early) diagnoses. Methods: Data and information collection on healthcare services, their acce ssibility, rate of use, expert consensus, and official regulations. For all three case studies, expert interviews were carried out with main actors. Results: Risk-group screening is not a priority in Austrian federal health policy. Although health promotion and prevention is a national task, examin ations for early detection of specific diseases (i.e., carcinoma) are left to the health insurance funds, which delegate the decision to offer early d iagnoses to their contracted physicians. In this opportunistic screening, g eneral practitioners or specialists are encouraged by their health insuranc e funds or motivated by professional guidelines to offer certain examinatio ns. Conclusions: Screening is a coordinated effort to acquire a grasp of a comm on disease at an early stage in a specified population. To achieve this obj ective, a culture of coordination and centralization has to be implemented. The collection of data is an essential element in coordination of decentra lized medical interventions as much as quality control is an essential task in looking at and comparing the outcome of interventions. In the three cas e studies, neither of these two essential criteria were met. Evaluations an d scientific evidence on the effectiveness of interventions were not used.