|Implemented in this survey?|
The e-card is a chip card for insured persons, which will replace the vouchers previously needed for health service utilisation and thus will offer paper-free access to all health care services. Currently its main purpose is to demonstrate a patient's eligibility for services. It is planned that in the future these electronic cards will enable providers to access other patient data and that subsequent cards will be used to store health relevant information if patients wish so.
The low degree of integration between providers in the Austrian health care system is suspected to result in expensive diagnostic services performed more often than necessary. Patient e-cards in
combination with provider key-cards should enable providers to get access to existing diagnostic results stored centrally.
During the introductory phase, the main purpose is to demonstrate a patient's eligibility for services.
The card is limited to information relevant for patient identification (Key card) but at first is not meant to store health data on it.
|Medienpräsenz||sehr gering||sehr hoch|
Fo Austria, the idea of access to all services with a single card is innovative, even though not on an international level, see Germany and the European insurance card.
Public visibility of the e-card was dominated by media discussions on the troubles with the first contractor for developing the card.
After lengthy preparations, the European Council decided in March 2002 in Barcelona that a European Health Insurance Card is to be introduced in the member countries until 2005.
This card replaces the formulary E111, thus facilitates access to health services abroad and finally improves mobility.
Health insurances in 1996 realized that this purpose alone would not suffice the cost involved in the development of such a card. In Austria it was therefore decided to integrate the European and the Austrian health insurance card into one "e-card".
|Implemented in this survey?|
A new social security law in 1999 (56. Novelle des Allgemeinen Sozialversicherungsgesetzes) stated that the Federation of Austrian Social Insurance Institutions is to create a chip card
(="e-card") as a basis for an electronic administration system for social insurance in Austria.
Main criteria were
The first plan was to implement the card nationwide in 2001. Today, the plan is to distribute the cards during the year 2005.
The approach of the idea is described as:
Local level - early start on a local level (selected doctors offices in Burgenland)
Doctors voiced opposition as they felt to be forced into costly investments (computer equipment, card reading device). By now, it seems that an agreement could be reached:
contracted doctors ("Vertragsärzte") will be equipped with a card reading device and two doctors key-cards ("Ordinationskarten").
Consumer protection activists fear that the card will not be safe and will facilitate access to health data for the 'wrong' persons like employers.
|Social health insurance||sehr unterstützend||stark dagegen|
|Consumer protection organizations||sehr unterstützend||stark dagegen|
|Social health insurance||sehr groß||kein|
|Consumer protection organizations||sehr groß||kein|
In 2001, the Austrian Federation of Social Security Institutions authorised the EDS/ORGA consortium to implement the e-card Austria-wide. The purpose of the consortium was an Austrian-wide
roll-out of the e-card until May 2003. As the EDS/ORGA consortium was no even able to make a conceptual design the Austrian Federation of Social Security Institutions cancelled the contract with the
consortium in March 2003.
As a consequence the Austrian Federation of Social Security Institutions set up a new tender for the e-card project. To guarantee an efficient and quick implementation, the Austrian Federation of Social Security Institutions decided to realize the project with 6 subprojects:
Subproject 1: set up the operation centre and the terminal software, so to say the heart of the e-card system
Subproject 2: creation of the chip card itself
Subproject 3: set up the communication services
Subproject 4: set up a call centre - to enable an efficient communication between the patients and contractual partners
Subproject 5: training of the users
Subproject 6: administrative client - to guarantee an simple and efficient system administration
Subproject 1, 2, and 4 are now in the implementation process.
On December 15th the test stage starts at one doctor's office in Burgenland, followed by a test run at 80 doctors offices in the first quarter of 2005. The Austria-wide roll-out is planned for the second quarter 2005.
When a copayment of then ATS 50 (3,60 €) per voucher was introduced in 1997, it was stipulated that this co-payment once will be abolished together with the voucher. Now, in contrast to this,
a copay of 10 € per person and year is charged to make up for revenue loss due to abolished copays per voucher. This copay is called a 'service fee' rather than payment for the card or simply
In an interview the MoH stated that because of the difference between voucher revenues (47 Mio €) and e-card revenues (37 Mio €) health insurance has to consider to generate additional copays.
Costs for introduction of the system are covered by the social insurance; however, employers contribute 21,8 Mio € once for their reduced administration expenses due to the abolished vouchers.
Early estimates (1999) by social insurance institutions were that efficiency gains caused by the e-card system will balance their introductory costs within two years. Total cost then was estimated at 700-800 Mio ATS (51-58 Mio €).
We believe that technical difficulties / time delays during the implementation process and the cost of introducing the card may outweigh efficiency gained by a reduction of medically unjustified diagnoses/treatments and by streamlined administration.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
Quality: If the utilisation of the e-card contributes to provide just the number of diagnostic services which is medically necessary, this would improve quality of care. This effect, however,
can result only if indeed phase 2 (Key card) will be implemented.
Equity: Maybe a twofold effect:
Cost efficiency: Early estimates (1999) by social insurance institutions were that efficiency gains caused by the e-card system will balance their introductory costs within two years. Total cost
then was estimated at 700-800 Mio ATS (51-58 Mio €). The technical difficulties / time delays during the implementation process raise doubts that efficiency gains will indeed cover the cost of
introducing the card.
We believe that the net effect of this policy will be neutral because expected outlays still may be higher than improvements in both, quality and cost efficiency.
Maria M Hofmarcher, Monika Riedel, proof read: Jan Pazourek/social health insurance fund, Vienna