Utilizando subconjuento de 16 Rasgos

There was a national organisation in 14 countries that was responsible for providing screening recommendations to varying extents (Table 8). In 2010, officials had been considering the creation of a national screening body in Switzerland, however, there was no screening organisation as yet. With the exception of Spain, all screening bodies made some form of evidence-based screening recommendations at the national level. In Spain, regional authorities were permitted to make screening recommendations that the Ministry of Health had to approve before introduction.

The decision-making and implementation of screening recommendations was at the national level in the UK, New Zealand and the Netherlands. In the other 11 countries, these responsibilities were delegated to the regional, local, or municipal bodies and via insurance schemes. In France, Germany and Belgium, decisions to introduce screening programmes were applied at the national level, however, the responsibility to implement them was delegated to lower levels. In Canada, Sweden and Australia, both the decision to introduce and implement screening programmes was devolved to the regional or local level. In Finland, Italy and Denmark, the national screening organisation asked municipal and regional authorities to introduce screening programmes with differing amounts of authority. Lower level authorities were obligated to introduce some screening programmes but did not have to introduce others. In the US, decision-making was previously delegated to the individual states and health insurance plans (including Medicare, Medicaid and the Veterans Health Administration), as guideline recommendations and coverage decisions were separated. Thereafter, under the Affordable Health Care Act, screening programmes that the United States Preventive Services Task Force (USPSTF) recommended with a grade A or B (see Section 5.4.6 below for grading) had to be covered by health insurance plans. Screening programmes not recommended by the USPSTF Health plans could still be covered by insurance plans. Therefore, in the US, Finland, Italy and Denmark, lower level bodies were able to introduce screening programmes not endorsed in national recommendations.

GBS screening recommendations or policies across many countries were not developed by the national screening agencies identified above. In Australia, the Czech Republic, Germany, Italy, Japan, the Netherlands, New Zealand, Spain and Switzerland, GBS screening recommendations were developed by professional medical societies, such as obstetrics and gynaecology societies. The screening organisations in these countries did not have a GBS recommendation on their website. In Belgium, GBS screening recommendations were developed by the Ministry of Health, however, it was not clear whether the Ministry was

responsible for developing other screening recommendations as well. In the US, the CDC, a national disease prevention agency, developed the GBS screening recommendation, however, it is the USPSTF that is nationally responsible for screening. The USPSTF does not have a recommendation on GBS screening. The national screening agency in France did make the GBS recommendation, however, this recommendation was dated before the publication date for the policy manual to assess screening programmes. Only the GBS recommendations in Canada and the UK were made by the national screening organisation.

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Table 8. Screening systems across countries

Name Organisation Recommendation Decision-making Implementation Other GBS screening recommendations

Australia

The Screening Subcommittee, Australian Population Health Development Principal

Committee National Regional Regional

Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Belgium Superior Health Council National National Local

Canada

Canadian Task Force on

Preventative Health Care National Regional Regional

Canadian Strategy for Cancer Control: Screening Working Group

Society of Obstetricians and Gynaecologists of Canada (SOGC) Canadian Paediatric Society

Czech Republic Czech Gynaecological and Obstetrical Society

Denmark National Board of Health National/Regional National/ Regional Regional Finland

National Screening Committee, Ministry of Health and Social

Affairs National/Municipal National/Municipal Municipal

France Haute Autorité de Santé National National Local through health insurance

Germany The Federal Joint Committee National National Regional through health insurance Working Group of the scientific medical professional societies Italy National Observatory Screening National National/ Regional Regional

GBS Prevention Working Group of Emilia-Romagna.

Japan

Japan Society of Obstetrics and Gynaecology Japan Association of Obstetricians and Gynaecologists

Netherlands

The Health Council National Institute for Public

Health and the Environment National National National

Dutch Organisation of Obstetrics and Gynaecology

Dutch Association of Paediatrics (NVK)

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Name Organisation Recommendation Decision-making Implementation

Other GBS screening recommendations New Zealand

National Screening Advisory Committee

National Screening Unit National National National

Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Spain Ministry of Health, Social Services and Equality Regional Regional Regional Spanish society of obstetricians and gynaecology Sweden The National Board of Health and Welfare National Local Local

Switzerland Considering national recommendation and decision-making organisation Swiss society of neonatology UK UK National Screening Committee National National National Royal College of Obstetricians and Gynaecologists

US United States Preventive Services Task Force National

National coverage for a set of conditions Regional: health insurance National: Medicare, Medicaid, Veterans Health

Centers for Disease Control and Prevention

American College of Obstetricians and Gynaecologists

American Academy of Paediatrics

GBS group B Streptococcus, UK United Kingdom, US United States of America, Recommendation: geographical coverage for screening recommendation, Decision-making geographical coverage for decisions to introduce screening, Implementation: geographical level that screening programme is implemented.