Between Hospital Chaos and Private Doctor Boom: Court of Auditors Warns of Collapse

The Court of Auditors (RH) presented the report on Friday, which had already caused a stir in its draft version in the summer due to the recommendation to disempower the regional medical associations. This is also included in the final report to facilitate the conclusion of an Austria-wide overall contract between the fund and doctors. A sustainable financing of the Austrian Health Insurance Fund (ÖGK) is also demanded, including through co-payments.

The RH criticizes that a modern, nationwide overall contract between the ÖGK and the Austrian Medical Association (ÖÄK) has not been achieved since 2019. However, this would be important for performance equity, system acceptance, and control, according to the auditors. At the same time, from 2019 to 2023, the number of filled positions in general medicine relative to the population decreased by 5.1 percent. Already in the period from 2009 to 2019, there was a decline of 10.2 percent.

Legislator Should Intervene

The legal framework conditions, according to the RH's criticism in a press release, complicate a negotiated solution because the approval of not only the Austrian Medical Association but also each regional medical association is necessary. The Court of Auditors therefore recommends that the Ministry of Health prepare a government proposal to change the framework conditions for the legally required uniform overall contract, for example, by eliminating the need for approval from individual regional medical associations.

The auditors are primarily concerned with ensuring the provision of insured services through fund-financed benefits in kind. There is "comprehensive need for action" here, according to the RH, as ÖGK-insured individuals are already spending significant private funds on elective doctors. In 2020, elective doctor bills amounting to 369.04 million euros were submitted to the ÖGK, and by 2023, the amount had risen to 551.45 million euros. In 2023, 208.85 million euros were reimbursed, 16 percent of the expenses for the outpatient sector.

Warning of Increasing Elective Doctors

From the perspective of the Court of Auditors, there is a risk that the elective doctor sector will continue to rise without countermeasures, and gaps in the provision of benefits in kind could emerge. It does not consider it appropriate to avoid co-payments with reference to social considerations while simultaneously accepting the emergence of gaps in the provision of benefits in kind. Instead, private payments from patients into the care system should be optimally designed according to financial, administrative, care policy, and social criteria.

In general, the financial framework conditions of the ÖGK are in tension with the goal of expanding performance in the outpatient sector. "So far, neither the care goals of the Austrian Health Structure Plan (ÖSG) for the insured have been met, nor have balanced finances been achieved," is the sobering conclusion of the RH on the audit covering the years 2018 to 2023. The financial situation of the ÖGK has significantly deteriorated during this period, with the fund itself expecting a "further drastic deterioration" by 2029.

Ensure Financing of the ÖGK

Sustainable financing must be ensured. In view of the challenges in care and financing, the timely reorganization of payment flows for the hospital outpatient and outpatient sector according to the principle "money follows performance" is indispensable. "This is intended to optimize the available financial resources and avoid inappropriate shifts in performance," the RH insisted on the interconnection of the ÖGK's management with that of the federal government, the states, and the other social insurance carriers.

The RH also looks with concern at the health economic and political key data: Austria's health system became more expensive again in the period from 2018 to 2023, with health expenditures amounting to 4,663 euros per person, ranking it second in the EU average. At the same time, life expectancy decreased: in 2023, it was only 0.1 years above the EU average, whereas in 2018 it was 0.8 years. The development of preventable mortality is also less favorable in international comparison. In comparable EU countries, it is more often possible to avoid hospital admissions - for example, due to diabetes or high blood pressure - thanks to appropriate outpatient care.

Calls for Reforms

RH President Margit Kraker emphasized in a podcast of the Court of Audit that a comprehensive agreement will only be reached "if actions are based on facts and mutual resentments are set aside." She identified "a real need for action" in financial terms at the ÖGK.

Health Minister Korinna Schumann (SPÖ), on the other hand, saw the need for structural reform confirmed in a statement. She rejected the recommended curtailment of the medical associations: "To announce in the media the disempowerment of a partner in the healthcare system by law is disrespectful and not my style." She also dismissed co-payments. The aim is "not to make medical care more expensive for everyone, but to push back the private sector."

For NEOS "High Time"

NEOS Secretary General and Court of Audit spokesperson Douglas Hoyos stated that it is "high time we end the financing jungle and the confusion of competencies and ensure with single-source financing that the federal government, states, social insurance carriers, and medical associations work well, more cost-effectively, and efficiently together." The Austrian health system is "very, very expensive, but extremely inefficient."

Criticism of the federal government came from the Greens. "Austria urgently needs a strengthening of the outpatient sector, binding waiting time transparency, and a modern, nationwide uniform comprehensive agreement of the ÖGK. But instead of addressing these structural challenges, the federal government yesterday decided to create three health reform funds, doing exactly the opposite and further cementing the status quo," said the health spokesperson of the Greens, Ralph Schallmeiner.

FPÖ Identifies "System Failure"

The FPÖ identified a "system failure." Health spokesperson Gerhard Kaniak warned in a statement: "Fewer panel doctors have to care for more and more people. For people in need of care, this means longer waiting times, less continuity in care, and more frequent unnecessary hospital stays - with fatal consequences for nursing staff and relatives." An alarm signal is also the "boom" in elective doctors: "When the panel system fails, the socially disadvantaged, people in need of care, and people with disabilities are systematically disadvantaged," added care and disability spokesperson Christian Ragger in a statement.

Peter McDonald, the chairman of the Conference of Social Insurance Carriers, saw the report highlighting challenges that also need to be addressed from the perspective of social insurance to remain future-proof as a health system. He particularly supported the demand for a reorganization of the financial flows in the hospital and outpatient sectors and the associated disentanglement of the federal constitution concerning the health topic, it was said.

(APA/Red)

This article has been automatically translated, read the original article here.