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17 September 2024 | Country Update
Implementation of the “digital before outpatient before inpatient” policy -
01 December 2023 | Policy Analysis
New healthcare reform 2024–2028 strengthens digital and ambulatory care
6.2. Future developments
Following general elections in October 2017, the conservative People’s Party (ÖVP) and the Austrian Freedom Party (FPÖ) formed a new coalition government on 18 December 2017, which reassigned responsibilities of several ministries. In particular, the Federal Ministry of Health was merged with the Federal Ministry of Labour, Social Affairs and Consumer Protection, forming the new Federal Ministry of Labour, Social Affairs, Health and Consumer Protection (BMASGK).
In January 2018, the new federal government presented its governmental programme, which revealed substantial overlaps with the previous health reform agenda, for example concerning strengthening of primary health care, reallocation of resources, focus on public health and health literacy. However, the programme also envisages structural changes with a potentially major impact for the organization of the health care system and SHI funds (BKA, 2018b). Most importantly, the programme foresees a merging of the nine regional SHI funds which would create only one major Austrian SHI fund (Österreichische Gesundheitskasse) covering almost 80% of the insured population. The government expects efficiency gains and savings in administration. However, a recent major review of the Austrian SHI argues that the large number of insurance funds is not the greatest obstacle to efficiency. Instead the separate procurement of providers (SHI funds versus Länder) and limited risk adjustment pose the most important challenges (LSE Consulting, 2017). The government also plans to further harmonize services and cost-sharing levels across SHI funds (see section 3.4).
The reform of the primary health care system, that was initiated with the development of a new approach to the provision of primary health care during the first Target-Based Health Governance Reform period (2013–2016) and ultimately led to the Primary Health Care Act (2017), will remain a major priority. The government aims to further develop the new primary health care approach and address persistent challenges. In particular, raising the attractiveness of primary health care will be a priority to ensure the successful implementation of the new primary health care concept given the stagnating interest of health professionals to work in primary health care and their demographic characteristics, namely the ageing of the physician and health workforce population. Also regulation of new contractual agreements and start-up programmes will support the implementation of new primary health care units across the country. Finally, a holistic approach of primary health care will be enhanced through improved coordination with public health services.
A comprehensive healthcare reform for the period 2024–2028, under the slogan “digital before outpatient before inpatient” is currently being implemented. This reform package covers a number of areas, including the establishment of a primary entry point (without gatekeeping) to the health system via the expansion of digital services (for example, through teleconsultations), supported by the expanded use of electronic health records and other e-health solutions (including virtual hospitals).
Other important streams of the reform focus on strengthening health promotion and prevention. Both areas will receive significant more funding as part of the healthcare reform 2024. Federal, state and social insurance projects will be merged in order to avoid duplication. The so called “Agenda Health Promotion”, including funding for climate and health, will be continued from 2024 to 2028. Further plans comprise the nationwide roll-out of the early childhood intervention programme for pregnant women and young parents. There are also plans to reform services within public health, for example, the work of public health officers.
Authors
In November 2023, the government presented a comprehensive healthcare reform package for the period 2024–2028. Under the slogan “digital before outpatient before inpatient”, the reform aims to establish a primary entry point (without gatekeeping) to the health system via the expansion of digital services, further alleviating the strain on the inpatient sector by strengthening ambulatory settings.
Through the reform a total of EUR 14 billion will be available for the health and long-term care sectors. This is the result of long financial equalization negotiations between the federal government, federal states, municipalities and the sickness funds (negotiations usually take place over the course of five years according to the Financial Equalization Act). As a result, the federal states as well as the sickness funds have agreed to take on new tasks as well as implement and support reforms. The main points of the reform can be summarized as follows:
- Expansion and strengthening of digital health services (EUR 51 million per year)
- Connection of the existing health hotline 1450 to an appointment service centre
- Strengthening ehealth services as first, non-binding contact, points (for example, video consultations)
- Obligation of all ambulatory providers (including private doctors) to use electronic health records (ELGA) and to code diagnosis
- A platform for the secondary use of healthcare data
- Strengthening the ambulatory sector (EUR 300 million per year)
- Hundreds of additional positions for contracted physicians in ambulatory and especially in primary care are planned. This is now possible, in part, because the Austrian Medical Chamber’s former veto power in determining and creating new positions for physicians has been revoked, and because the Regional Structural Plans for Healthcare will become binding and replace negotiations with the Austrian Medical Chamber on the number of new positions created.
- An overdue standardization of the contract1 between SHI funds and the Medical Association will ensue. This initiative will address the persistent regional differences within the same insurance framework thereby ensuring equitable and standardized provisions across the country.
- Structural reforms in hospitals (EUR 600 million per year)
- Hospitals will undergo structural reforms and receive more funding specifically earmarked for the expansion of day clinics and specialized outpatient hospital departments with the aim to build stronger networks of specialized care and supra-regional structures as well as offer more care possibilities for rural areas.
- Improving medicine supply (EUR 3 million per year) and vaccination programme (EUR 90 million)
- The use of new, costly drugs will no longer be part of bilateral negotiations between individual hospital operators and the pharmaceutical industry. Rather, these will be reviewed by an independent evaluation board that will provide recommendations based on objective and scientific criteria.
- The implementation of a comprehensive, publicly funded vaccination programme emphasizing collaboration as opposed to fragmented responsibilities and isolated solutions will be implemented.
- Nursing and Long-Term Care (EUR 1.7 billion per year)
- For the implementation of the care and long-term care reform, adopted in 2022 (link), an additional EUR 1.7 billion were secured during negotiations designated for long-term care.
- Health Promotion and Prevention (EUR 60 million per year)
- An additional EUR 60 million per year will go into health promotion and prevention programmes, in particular early childhood interventions programme such as “Frühe Hilfen” for pregnant women and young parents, which will be rolled out across the country.
1 This refers to the last reform of the sickness funds in 2020 where the nine former Gebietskrankenkassen were fused into the ÖGK. While the fusion took place, the contracts (benefit package, remuneration of doctors) were not harmonized. See HIT 6.2. Therefore, the federal and regional medical chambers negotiate collective contracts (Gesamtverträge) with the HVB (on behalf of the corresponding SHI funds) on a regular basis.