Stay away: co-payments for all discriminate against women and at-risk groups

Reforming the system of social insurance providers has been identified as one of the important goals of the new Austrian government in the Government programme 2017-2022, leading to a renewed interest of broader public in the related topics. In this report, we provide estimates of the effect of introducing co-payments (Arztgebühr) per doctor visit and analyse their impact across demographic and socio-economic groups. We find that effects of co-payments per doctor visit would be highly asymmetric, affecting disproportionally more women, elderly, and people with lower educational attainment. Introducing co-payments could generate additional revenues between 520 and 670 million euro per year (ca. 60 to 80 euro per capita) for the providers of public health insurance. Although co-payments would increase revenues of the health insurance providers, the impact on equity and fairness is clearly negative.
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Health policy approaches in the 2017 Austrian coalition agreement: Politics on the old ways, the shoes re-laced, the wine sour

We analyze health policy ideas and measures of the 2017 Austrian coalition agreement in terms of access, quality and efficiency and characterize selected aspects according to their main content in terms of services supply, demand, financing, governance and transparency.
for more information see: PDF, in German

Increasingly unpopular: Private health expenditure, cost sharing stagnates

Prescription drug expense cap and ongoing bonus programs led to stagnated growth of cost sharing in recent years. Direct payments to providers and institutions rose sharply in the long-term care sector and in ancillary services and medical aids. Thereby since 2010 self-payments significantly grew faster than economic output. Direct payments to doctors amounted in 2014 about 500 million, of which about 390 million euros went to private specialists. Formally these payments are hidden cost sharing because patient choice is limited by the social health insurance system. Convention in Austria is that doctors can be freely selected in principle, but not a full or partial refund is done in any case. The pricing in private doctor’s areas and in non-medical providers is largely left to market forces. The expansion of care delivery in the area of social health insurance is long overdue and necessary from a social point. This should be accompanied by increased efforts to better overlook tariffs outside of the social health insurance system. In addition, in-depth analysis is needed on the social dimension of self-payments and cost sharing.
for more information see: PDF, in German

New Challenges Smart investments for a sustainable health care system

I gave a talk at a 2015 European Forum Alpbach: high level partner program involving key stakeholders where "New Challenges Smart investments for a sustainable health care system“ were addressed. I focused my talk at “Current Status Austria: New Challenges for the Health Care System”. My key messages are:

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Health system performance in Austria has improved but it needs more effort

Health spending limits as stipulated in the Austrian health reform legislation 2013 are met in 2013 and likely also in 2014. Throughout 2018 it will be increasingly difficult to adhere to the requested budgetary framework as economic conditions have weakened. To gradually adjust the financial performance of the health system to overall economic conditions would require containing about 1,7 billion Euros additionally in 2016. Supply performance has somewhat improved by increasing day care up to thresholds and by reducing bed-days as demanded. However, structural change in care delivery through building improved primary care capacity is slow and targets set in this area are meagre. Also, quality management across care sectors appears below targets and the implementation of electronic health records is stalled. Sustainability is somewhat at risk. Cost is likely pushed through renewed wage settlements across the country for hospital doctors in response to the implementation of EU working-time directive. Further, price pressures coming from new and innovative drugs might accelerate, also in light of yet unmet chronic care needs. Thus far health reform failed to establish a commission, which was proposed to optimize high price drug use across care sectors.
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Science and research in the healthcare system ensures growth and well-being

In this contribution I argue that research and development (R&D) especially in the health care sector has significant potential to improve the health and quality of life of the population and to create jobs for highly qualified employees, in particular for women. Finally, R&D in the health care sector should be strengthened to optimize the use of healthcare resources. Follows the R&D performance in the Austrian health care market, general government objectives under the EU 2020 strategy 530 million euros are additionally required.
for more information see: PDF, in German

Pharmaceutical care provision in Austria requires more patient orientation

In May 2014 I participated in an event organized by the chamber of physician of Lower Austria to discuss issues of dispensing rights given to doctors. This chamber is active to promote widening dispensing rights of practising physicians outside hospitals. These providers run currently about half of public pharmacies in an environment of strong territorial protection. Austrian legislation in recent years relaxed market entry for pharmacies in response to European regulation to promote freedom of establishment. Consequently market shares of dispensing doctors are increasingly difficult to maintain. While the majority of Austrians prefer both licensed pharmacies and dispensing physicians research suggest that cost effectiveness of dispensing doctors is largely inconclusive. Moreover, recent evidence from Switzerland suggests that direct and indirect cost per patients induced by doctors´ dispensing exceeds cost incurred by non-dispensing peers. In my intervention I proposed to optimize pharmaceutical provision through establishing a policy-led and moderated dialogue between relevant stakeholders which should aim at working towards better cooperation to improve patient care while also aiding the development of responsive primary care delivery in group practices, a main objective of the 2013 health reform.
for more information see: PDF, in German

Austrian Electronic Health Records on the march

Key actors including the Minister of Health discussed issues related to the implementation of Electronic Health Records (ELGA) in Austria in the live TV show IM ZENTRUM (www.orf.at) where I participated on March 9, 2014. ELGA is currently rolled-out and should fully operate across providers by 2016. Designed as a network combining local servers of providers through specialized software and by using the e-card as a key covering almost 99 per-cent of the population, ELGA has met fierce opposition in particular from primary care providers but also data protection advocates. Main arguments are that ELGA increases the burden of work, is not easy to use and data security is not ensured. As a consequence medical doctors have been organising structured protest, e.g. encouraging patients to opt-out, a central feature of ELGA. Currently about 80.000 or 1 per cent of e-card holders have opted-out. While improvements in usability and transparency are certainly needed, ELGA likely enhances efficiency in the Austrian health care system, a key objective of the Health Reform 2013. I summarize key points of my interventions as follows.
for more information see: PDF, in German

Trends in health care expenditure could tolerate further reform

After slumping in 2010 and 2011 Austrian health expenditure increased again in excess to GDP growth. This likely jeopardizes efforts to contain cost growth through a global budget cap on public health expenditure introduced in 2013. While the development of public expenditure is slower and less volatile when compared to private spending, growth differentials reflecting imbalances persist. In fact, public spending growth of hospitals including rehabilitation and long-term care facilities is strong probably indicating that capacity is not fully utilized. On the contrary spending growth of ambulatory care run by private doctors is modest. To realize health sector expenditure to grow in line with GDP requires better utilization of existing hospital capacity and further measures to improve multi-stakeholder relations including merging sickness funds, better pooling of resources and targeted allocation of funds. This would imply important structural reforms of the current governance model, a change that is unlikely to happen in the near future,
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Health policy approaches in the 2013 Austrian coalition agreement: All you need is a health reform!

Health Policy approaches in the 2013 Austrian coalition programme largely reiterates measures defined in the 2013 health reform package. Central to this is a global budget approach through impact-oriented contracts. Tax-funded subsidies for health insurance will be kept in spite of balanced budget sheets. While the programme stresses the importance of prevention for child and occupational health it also recognizes the health sector as a significant employer and economic sector. To address risk factors taxes on alcohol consumption and tobacco will be increased which likely favours better-off groups. The programme confirms to further promote long-term care services rendered at home. While needs-based cash benefits are the most important financing pillar in this area, income and asset tests remain key when nursing home care is utilized,
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Health policy approaches in the 2013 German coalition contract: Path-dependent with promises for better quality and more innovation

Health policy approaches in the 2013 German coalition contract are largely path-dependent. First, the contract continues to shift financing responsibilities of future cost growth onto employees as employer contributions are frozen. Second, it indicates strong support for individual doctors´ freedom to practise while leaving the divide between general medicine and specialty ambulatory care largely untouched. To foster innovation in service delivery additional funding will be available although the amount – at about 200 million Euros – is moderate. More funding is foreseen for long-term care, which also involves the establishment of a long-term care fund to accumulate reserves. This fund will be operated at the Bundesbank likely indicating that monies flowing into this fund will be assessed,
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What does it take to achieve progress with e-health

I gave a keynote talk at the 5th Forum on electronic health records in Austria (ELGA), organised by “Business Circle”: I presented arguments for more e-health in the health sector, summarized recent evidence on the impact of e-health and assessed Austrian efforts in the current health reform legislation. I concluded that effective e-health requires alignment of payment mechanism across health care sectors. Further, remuneration of ambulatory care providers needs financial incentives to promote the adequate use of technology and software. Importantly, regulation needs to be refined to promote secondary data analysis to enhance the evidence base for policy making. Finally, I propose to collect data on jobs created through emerging e-health to facilitate productivity measurement in the health care system,
for more information see: PDF, in German

Market volume of cosmetic surgery in Austria: The beauty of real data is missing

As everywhere cosmetic procedures have become popular in Austria. Cosmetic procedures in Austria are mostly done in private practice including privately owned hospital facilities or private beds that are also available in public hospitals. Usually cosmetic procedures can be classified in a) cosmetic surgical procedures, b) cosmetic minimally invasive procedures and in c) reconstructive procedures. There are practically no data available in Austria, which would allow providing specific information about the market volume of cosmetic procedures. The government needs to ensure monitoring of volumes and fees charged in this area to observe the real volume and importantly to better oversee performance in this area in particular quality,
for more information see: PDF: Market volume of cosmetic surgery in Austria