Health promotion and preventive care is a recent focus of Austrian health care. It was only in
1992 that general disease prevention measures were added to the legal mandate of the social insurance system. Screening for diseases such as cardiovascular diseases, cancer and diabetes mellitus is increasingly utilised. There is a basic screening programme and a gynaecological programme. Preventive care is mainly provided by general practitioners and gynaecologists under insurance contract and the ambulatory services of the sickness funds. The emphasis on preventive care implies improvement of information and documentation on health status and health outcome of the population.
Primary health care is provided mainly by physicians in single practice. Austrian physicians are
in principle free to set up independent practices but in reality it is necessary for most practitioners to contract with a sickness fund. Patients are free to choose their own doctor, but if patients covered by a social insurance consult a ’non panel’ doctor, they must pay the fees directly and are later part- reimbursed. Some funds require co-payments whichever doctor is consulted. Specialists are normally only consulted following referral from a general practitioner. With regional differences,
Health Care Systems: Austr a
insurance agencies and over 60% of the private clinics have public contracts. Both the public clinics and hospital outpatient departments have increased their range of services in recent years, especially in regions with a shortage of private physicians. Voluntary welfare organisations and self-help groups provide substantial medical and social services and the Austrian Red Cross provides most of the ambulance and transportation services - up to 90% in some provinces.
Hospital planning was more or less up to the provinces until the beginning of 1997, when the
Federal government and the Länder agreed on a framework for a hospital and major investment plan. Hospital beds are mostly public, mainly provided by Länder governments (54.5%), Communes (16%) and sickness funds (8%).
Hospital bed supply is above the EU average. Austria provided 53,115 hospital beds in acute care in 1994 and provided 6.6 inpatient hospital beds per 1,000 population {4.7}. There are substantial regional variations in the availability of beds in acute care. The number of hospitals beds in acute care has been reduced substantially since 1994. The inpatient average length of stay in acute care in spite of an above-average reduction during the past decades, at 7.9 days, is still fairly high by European standards {7.6}. The number of cases treated per hospital bed was 33.9 in 1993 {31.3}. The level of costly medical equipment is in the upper quartile of the EU, for example, the level of extra corporal shockwave lithotripters for the treatment of urinary and gallbladder stones was highest in the EU in 1990.
The number of practising physicians, 25.6 per 10,000 population, was below the EU average {28.1}, with general practitioners amounting to 12.1 {8.2} and specialists amounting to 13.4 per 10,000 population {11.3}. There are reported local shortages of qualified nursing staff in spite of an above EU-average level nationally. The number of dentists and pharmacists in particular is below the EU average.
Table 9: Number of Health Professionals in Austria
Professionals Number per 10,000 EU average Year
population
Practising physicians 26 28 1994
General practitioners 12 8 1994
Specialists and consultants 13 11 1994
Practising dentists 4 6 1993
Certified nurses 80 70 1993
Practising pharmacists 5 8 1994
CURRENT ISSUES IN HEALTH CARE
A major focus of current health care in Austria is the implementation of the hospital financing system. The new financing system, which resembles financing according to Diagnosis Related Groups, aims to stabilise expenditure growth in the Austrian hospital sector, increase efficiency of hospital care, decrease length of inpatient hospital stay and improve quality of hospital care. The
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new system will crucially depend on data quality, as well as the quality of hospital information and communication systems. ’Quality strategies’ are being tested in a number of model hospitals. There are also powers to increase management capacities in public hospitals and to increase competition between the providers of hospital services.
There are still problems of coordination between hospital and primary care services. The structural changes in the hospital sector are expected to have an impact on ambulatory care services and there are some indications of reform of financing methods in ambulatory care. However, there is tension between the social health insurance authorities and the panel doctors in establishing new remuneration structures. Apart from that, there is a tendency to further strengthen the role of primary care in relation to secondary care and to increase initiatives for preventative service provision and health promotion. In this context there has been a call for the establishment of ’District Social Services and Health Units’ to coordinate the wide range of medical and social services available.
There are shortages of long-term care facilities which has led to patients no longer needing acute care occupying costly acute-care beds. To counter this, a legal provision for the financing of long- term care was introduced by a special Nursing Care Act in 1993. Existing facilities for long-term care will be extended in three stages, starting in the year 2000.
Health Care Systems: Belg um
There are conflicting projections for the future proportion of elderly people. 12
BELGIUM