|Implemented in this survey?|
The Austrian government is promoting the creation of health purchasing agencies on state and federal level in order to optimise resource utilization, enhance integration of service delivery and pool financial resources to improve purchasing. The main task of these agencies is to purchase services according to predefined quality standards and prices. If implemented, the creation of these agencies would constitute the most important health sector reform since the Social Security Act 1955.
|Medienpräsenz||sehr gering||sehr hoch|
|Implemented in this survey?|
The Health Reform 2005 (in particular the purchasing agencies) is currently being negotiated between federal and state governments within the negotiations on the financial equilization
(Finanzausgleichsverhandlungen). By January 2005 they must reach a general agreement on hospital financing. Thus the agencies are part of these negotiations. Two legislative drafts on
implementing the reform already exist; currently all main actors seem to oppose this proposal:
Sickness funds keep opposing the idea of the agencies, mainly because of their likely loss of influence (agencies would be responsible also for service provision outside of hospitals - ambulatory care, nursing homes etc, unlike the former state agencies which covered hospitals only). The legislative draft does not yet contain information on the balance of (voting) power within both, federal and state agencies. Rumours indicate lower than proportional power for sickness funds.
Doctors' chambers are not allocated any say in the agencies. Doctors fear that the agencies will gain 'monopoly power' in purchasing services. Currently the chamber of physicians has Professor Rürup, a well known health economist and health policy advisor to the German Government, evaluating the reform proposal to arm themselves if negotiations with the states progressed.
Hospitals: As the establishment of the agencies is likely to result in closing departments and even entire hospitals (this was proposed again and again, but could be achieved only partly), state governments fear to lose voters.
|sickness funds||sehr unterstützend||stark dagegen|
|doctors chamber||sehr unterstützend||stark dagegen|
|state governments||sehr unterstützend||stark dagegen|
Based on two legislative drafts the federal and state governments negotiate the reform within the negotiations on the financial equilization. Neither these drafts nor the
process have been disclosed so far and hardly any information is available.
The Minister is firm in her approach to establish purchasing agencies. However, experts and stakeholders seem to be quite pessimistic that the reform can be implemented within the envisaged time frame (January 2005).
Due to persistent criticism the Minister of Health has been responsive to reprovals that the newly proposed agencies will generate even more bureaucracy. In particalur she suggested that currently active institutional layers, i.e. the "Landeskommission" within states may serve as an administrative body of the purchasing agencies; furthermore, even the wording ("Gesundheitsagenturen") may be changed.
|sickness funds||sehr groß||kein|
|doctors chamber||sehr groß||kein|
|state governments||sehr groß||kein|
In September 2004 the Minister of Health gave a speech and reiterated three general health reform goals:
To achieve these goals she presented a priority catalogue:
We believe that the health reform 2005 will be difficult to implement:
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
If the government succeeded in incentivicing state governments to put all financial resources for hospital financing in one budget the effect on cost efficiency in the hospital sector may be high. Currently only about one half of the hospitals operating budgets is being financed performance oriented. The intention of the federal government is to have states to commit also the owners share of the budget and to remunerate hospitals solely on the bases of performance. If the government succeed on this, we believe that a big step is achieved to improve allocation in inpatient care even if the government had not succeeded in the creation of purchasing agencies. However, we are not too optimistic that this will be achieved across the country as some state governments are strongly opposing this approach, whereas others have already pooled all the financial means for inpatient care.
The Austrian Health Reform 2005
Topic: The improvement of the efficiency of the health care system and ensuring sustainable financing, Ministry of Health and Women, Austria May 2004
BMGF: Gesundheitsagenturen, Analyse und Modellansatz, Präsentation, Fachausschuss Soziales, Wien im Jaenner 2004.
Hofmarcher, M. M., M. Kraus, M. Riedel: Finanzierungsmodus der Fondskrankenanstalten nach Bundesländer, MIMEO, Institut für Höhere Studien, IHS HealthEcon, Mai 2004, Wien.
Various media reports
Maria M. Hofmarcher, Monika Riedel