The periodic health examination: from law to the directive of the German Federal Joint Committee (G-BA)

Since 1989 a periodic health examination beginning at the age of 35 for the early detection of "common diseases" (especially cardiovascular and kidney diseases as well as diabetes) by means of history-taking, physical examination, blood and urine tests and counselling has been available in Germany. Altogether, the respective directive of the Federal Joint Committee (G-BA) was revised six times, but a substantive change took place only once (i. e., the cancellation of uric acid, creatinine, and resting ECG in 1999). However, additional examinations (e.g., glaucoma screening) were not added to the health check after systematic assessments of the evidence were completed. In the mid-1990s, several evaluations were performed which showed that new diagnoses were established in a significant proportion of patients, and measures were initiated such as nutrition counselling. A patient-relevant benefit in terms of avoided adverse events (such as heart attacks) could, however, not be demonstrated due to methodological reasons. Criticism of the health examination is not new, in particular concerning the lack of evidence of benefit for the diagnostic procedures of the health examination. A draft law issued by the former Federal Government proposing an amendment to the health examination has recently been rejected in the Bundesrat (upper house of the German parliament).