A screening programme without the infrastructure to treat the detected diseases appropriately (and with equal access) would be senseless. Does the patient have the right to be treated in case of a positive screening result?

The EU considers that early detection procedures and techniques should be researched more thoroughly before being widely applied in order to guarantee that their use and application is safe and evidence-based; therefore, it is necessary that this research leads to unambiguous and evidence-based recommendations and guidelines. {54} This was written in the context of cancer care and prevention, but it can be assumed that this is a basic opinion, which is therefore also valid for other screening activities. Further, the opinion of the EU can be interpreted as requiring the defining of clear and transparent goals for the screening programme, which should be communicated to the public. {55}

Lack of resources

What about lack of resources for treatment (not enough heart surgeons)?Is treatment abroad required? How is the waiting list prioritised there?

Should the screening programme for AAA be initiated if adequate resources for treatment of positive findings are not clearly available?

Waiting lists

Are transparent waiting lists required? Are there any influences on waiting lists (e.g. corruption)? How could that be solved? Is there any necessity to influence the waiting list system by law? Is there any necessity to define a (legal) cut-off for some people who would not benefit from AAA screening (heart surgery, rehabilitation) even in the selected age group?

A study about long-term care reports that ‘most variability in advance care planning decisions was the result of differences among community-based long-term care providers (64%) rather than consumers' situational features.’ The authors ‘highlight the need for consistent educational programs regarding the role of the ... provider.’(Baughman 2011) {56}

The court decision {57} about treatment abroad states several conditions for reimbursement by the national health system. Basically it is different in terms of (AAA) screening, unless there are huge waiting lists for the screening examination, which does not seem very likely.

Structure and resources must be provided appropriately. EU action, to complement national policies, should be directed towards improving public health, and preventing physical and mental health illness. The EU and the Member States should foster cooperation with third countries and competent international organisations in the sphere of public health. {58} Member States shall be responsible for the organisation and the delivery of healthcare. Member States shall facilitate development and functioning of a network connecting the national authorities responsible for health technology assessment. {59}