National sections

Austria
The Austrian medical healthcare system

Dr Reiner Brettenthaler, Head of the Austrian UEMO delegation

The interest and the number of students taking up medical studies has remained as high as already described in last year's contribution to the reference book, a fact that continues to aggravate the problem of medical doctors out of work. The medical profession still enjoys the highest standing in the Austrian population and the access to medical studies is still free and not limited by any restrictions. As medical education is based on the 'Austrian medical study regulation', which has not been amended for twenty years, it is considered obsolete and too theoretical. This results in the fact, that in Austria, medical doctors graduate from their long studies (on average eight to nine years at university) have received only theoretical education and have to undergo additional three years of postgraduate practical training in general practice. This unsatisfactory tendency is to remain unchanged, as the calls on the part of the Austrian Medical Association for instituting a capacity and need-oriented medical curriculum did not find approval by politicians, and as the planned reform of medical studies will not be accomplished before the year 2002. In December 1998, there were 33,800 medical doctors in Austria exercising their profession, among them 10,800 general practitioners (GPs), 6,550 among them working in a self-employed capacity in their own practice.Suggestions for improvement made by the Austrian Medical Association include restricting the access to medical studies in introducing a two-semester preparatory course for first year students, but also the employment situation of medical doctors needs to be reformed. For many years, Austrian doctors have been interested in the possibility of co-operating with colleagues in group practices, which may on the one hand improve the difficult situation of the limited number of health insurance contracts for doctors, and on the other hand improve the range of services offered to patients (improved medical services and extended consulting hours so the patient will receive more attention). Unfortunately, this plan fails because of the restraint of those responsible for social insurance, who hold the opinion that a larger range of services goes automatically hand-in-hand with an increase in demand and in costs.Another particular problem of our system is the strict separation between the outpatient sector and the inpatient sector, as mentioned in last year's report. This separation also manifests itself in the dualism between the public health insurance financing predominantly the outpatient sector, and national tax proceeds funding the main part of the inpatient sector. Whereas the increase in costs in the inpatient sector is being practically exclusively financed by the budgets of the federal provinces, the development of the costs in the outpatient sector — that is the costs of the services provided by the self-employed doctors — is dealt with by the health insurance. For this reason, those responsible for health insurance show little interest in the extension of the outpatient sector, although this would be reasonable in many respects from the economic point of view.

In this context the Medical Association has made proposals with regard to the introduction of group practices of self-employed doctors as the 'missing link' between the inpatient and outpatient sector; however, none of these proposals has been put into practice.

Another approach to solutions considered by the Austrian Medical Association in this context is that the health insurance regains its primarily social character and assumes only those costs which the patient is not able to take over due to the enormous amount or social indigence, but that on the other hand the cost sharing principle should be considered and requested in the case of patients with a good income.At present, radical changes are in sight in the Austrian healthcare system, as the Austrian Parliament made an initiative to introduce an electronic chip card for patients, replacing the health insurance certificate currently in use.Social insurance in particular, but also the economy, intend to minimise the difficulties and costs involved in the use of health insurance certificates. Intense discussions on this issue have brought about several advantages for doctors, ie, the health insurance will be ready to reimburse each doctor a certain amount of the investment costs relating to the introduction of the chip card system, and also all justified fears and objections in connection with the transmission of data involving the risk of making the physician and the patient 'transparent' were eliminated.An extensive amendment to the Austrian Medical Law brought about considerable changes in the self-governing area of the Medical Associations established in the Austrian provinces. After the elections, which will take place within the first six months of 1999, the Austrian Medical Association representing the medical profession will be restructured according to three groups, ie, the self-employed, established doctors, hospital doctors and the dental doctors. This implies that the aforementioned groups of medical doctors will defend the interests of their group of doctors in an autonomous and independent manner, which will make the representation of interests of the medical profession more efficient.The satisfaction of the population with the medical healthcare system is extremely high. According to opinion polls, medical doctors in Austria are by tradition always shown as the professional group with the highest client satisfaction, and their efficiency is evaluated as very good. For this reason, criticism is quite rarely expressed against the quality of the healthcare system. Thus, problems in our healthcare system make themselves felt on the financing level. In times of moderate economic growth it is increasingly difficult to deal with the exploding demand for services resulting from accelerated medical progress and the demographic trend;therefore the majority of reform attempts undertaken in the past aimed at containing costs. However, we hold the opinion that the incapacity of health policies, criticised repeatedly during the last years, to develop strategic perspectives for the future and to put these into practice is caused by the fact that too little attempt has been made to seek the consensus with the organisations representing the interests of the providers of health services.