Health technology assessment of three screening methods in Switzerland

Objective: To describe the level of health technology assessments for three screening methods in Switzerland. Methods: Analysis of documents and expert opinions on mammography screening , ultrasound examinations during normal pregnancy, and screening for prosta te-specific antigen (PSA) with a focus on services provided, recommendation s, formal regulations, national papers, projects, and formal assessments. Results: Preventive services are explicitly recommended by the Swiss federa l law on health insurance. Two routine ultrasound examinations during norma l pregnancy as well as PSA analysis for men over 40 years of age on medical indication are covered by basic health insurance. Mammography screening ev ery 2 years has been covered since 1997 for women over 50 years. A systemat ic screening program for mammography exists in the western part of Switzerl and, and a nationwide program is planned. However, a national program may n ot come into being until a quality assurance program for evaluation is esta blished, and a nationwide fee for reimbursement-to include all costs of suc h a program-is accepted by providers and insurers. Conclusion: According to the Swiss health insurance law, the effectiveness of mammography screening and ultrasound examinations during normal pregnanc y have to be proven. Systematic evaluation of these screening methods is in preparation. PSA is not part of current evaluation. It can be concluded th at health technology assessment in Switzerland is now required by law for s everal medical services. However, limited financial and personnel resources as well as the lack of disease registers may hamper progress in the near f uture.