The Primary Health Care Act implemented in 2017 provided the legal framework for the establishment of primary health care units (PHC). These are multidisciplinary primary health care clinics run by at least three GPs who employ other health professionals (for example, nurses or psychotherapists). The idea behind the PHC units is to provide local communities, especially in rural areas, with an extended range of services. In addition, the PHC units are designed to provide GPs with a better work-life balance, more flexible working hours, shared financial risk and the possibility of working in interdisciplinary teams. Furthermore, the locally provided multi-professional range of health services aims to relieve hospitals’ outpatient departments.
Initially, 75 PHC units were planned by the end of 2021; however, due to disagreements between SHI funds and the Austrian Medical Chamber over staffing levels, collective contracts and fees only 39 had opened by March 2023. The Austrian Medical Chamber, which strives to protect the existing provider structures blocked the opening of new PHC units as it has a veto right on staff planning (see section 6.1 Analysis of recent reforms).
With an amendment of the Primary Health Care Act and a EUR 100 million budget from the RRF, the Austrian government wants to triple the number of PHC units to 121 by 2025. The goal is to improve access to primary health care, especially in remote areas, to increase the attractiveness of primary health specialties among graduates and young professionals and to better address local population needs. The following changes are planned:
- If at least two vacancies of GPs or paediatricians remain unfilled according to the vacancy plan negotiated between the SHI funds and the Medical Chamber, the latter loses its veto right. In that case, an accelerated PHC unit establishment procedure is applied, whereby the Austrian SHI Fund (ÖGK) can unilaterally tender for a PHC unit.
- A PHC unit does not have to be owned exclusively by medical doctors anymore, rather it can be owned by other (legally defined) health professionals under the legal form of a corporation. However, if the latter option is chosen, over 50% of shares are reserved for medical doctors. These new measures of the legal framework aim to promote the multidisciplinarity of PHC units while simultaneously allowing for-profit private investments in PC.
- A PHC unit must consist of at least three medical doctors, who may be GPs or paediatricians. Depending on the local needs, PHC units should also include gynaecologists and health professionals such as midwives, psychologists or psychotherapists, physiotherapists and qualified nurses as well as social workers.
- PHC units should ensure reasonably long opening hours, including early mornings and late evenings, weekends and bank holidays.
If passed, the law is expected to come into force in July 2023.