Broad debate in the committee about the current challenges in the healthcare system, from doctor training to staff shortages
Vienna (PK) – Back in 2013, the federal government, states and social insurance agreed for the first time on a contractually agreed organization of health care in Austria and, above all, on a cost containment path. The current monitoring report in this regard, which points to expenditure caps being exceeded in some cases, was one of many points on the agenda today Health Committee. Like the other templates, it formed the starting point for a broad debate about the most pressing problems in the domestic healthcare system with the responsible department head.
Against the background of the ongoing negotiations on financial equalization, Federal Minister Johannes Rauch considered it crucial that social security and the states take an overall view of the system. It is not enough to just “pump in more money”, what is needed above all is more commitment. In addition, Rauch repeated the statement he has already made several times, according to which the principle of “digital before outpatient before inpatient” must apply in the future.
Further reports dealt with the evaluation of the compulsory completion of a six-month teaching experience introduced in 2015 as part of training to become a general practitioner, the implementation of preventive measures in the area of social insurance and the department’s Corona expenditure as of June. All reports were acknowledged by the majority and are therefore considered final.
An amendment to the Health Target Management Act that was thematically related to the monitoring report and focused on repairing the matter in accordance with the constitution was accepted by a broad majority – with the exception of the FPÖ. On the basis of numerous opposition motions – postponed with the votes of the ÖVP and the Greens – the challenges already mentioned in the reports that the health care system in Austria is currently facing were taken up and, in some cases, controversially discussed. The topics ranged from financing modalities, solutions to the staff shortage, strengthening the outpatient sector to measures to increase the vaccination rate.
Health Target Control Act will be designed in accordance with the constitution
A government proposal, which was passed in the committee today with the votes of the ÖVP, SPÖ, Greens and NEOS, serves to repair the health target management law in accordance with the constitution. Specifically, this affects paragraph 23, which deals with the declaration of binding nature of the contents of the Austrian Health Structural Plan and the Regional Structural Plans. However, the elimination of two fundamental provisions does not change anything in terms of content, according to the explanations (2207 d.B.). Gerhard Kaniak (FPÖ) argued that his party would no longer agree to such “small repairs” because an overall reform was urgently needed, arguing the liberal rejection.
Monitoring report 2022: Spending caps are being exceeded even more significantly than in the previous year
An essential part of the 15a agreement on target management for health is a cost containment path that envisages a reduction in annual spending growth from 3.6% (2017) to 3.2% in each of the years 2021 to 2023, it says with the votes of the ÖVP and the Greens noted monitoring report (III-1002 d.B. ). In addition, strategic goals were defined in the areas of “better care, better quality and a healthier population”, the achievement of which will be measured using 22 indicators. The sixth comprehensive monitoring report, Health Target Management, shows fundamentally mixed results and trends, according to the authors’ assessment. According to the preliminary results, in the reporting years 2021 to 2023, the federal states as a whole will exceed their spending caps. In the case of statutory health insurance (KV), this trend will be apparent for all providers from 2022. The states and statutory health insurance together achieved an overrun of €206.55 million (0.80%) in 2021, which increased sharply to €1,027.82 million (3.85%) by 2022 and in the 2023 estimate monitoring This resulted in an excess of €2,143.44 million (7.77%). The authors point out that the achievement of goals in terms of both financial goals and control areas should be assessed more heterogeneously than in previous years. In general, all results from 2020 onwards should be interpreted in the light of the COVID-19 pandemic, although fundamental challenges and requirements for action will still remain.
It had been clear for a long time that the cost containment path could not be adhered to, said MP Rosa Ecker (FPÖ), so we should have reacted long ago. The underfunding of the private practice sector would also massively overload hospital outpatient departments.
Rudolf Silvan (SPÖ) pointed out that the number of “healthy years of life” had fallen in Austria, while a contrary development could be observed in the Scandinavian countries. In his opinion, this indicates that Austria is “lagging behind” when it comes to prevention.
Laurenz Pöttinger (ÖVP) replied that compliance with the spending caps had been quite successful for many years, and the current figures were simply due to the corona pandemic.
The second part of the report provides information about the achievement of the operational goals in the individual control areas, with the majority of the 22 defined metrics moving in the intended direction, stated MP Ralph Schallmeiner (Greens). It is highlighted as positive that the proportion of the population that was treated in primary care units continued to rise in 2022. However, the vaccination coverage rate for mumps/measles/rubella among children under the age of two is viewed critically, as is the lack of common cross-sector or cross-state drug procurement. There is hope that some problems can be solved within the framework of the financial equalization, as in his opinion the states have become serious.
Federal Minister Johannes Rauch saw the current financial equalization negotiations as a great opportunity to make important decisions in the healthcare system. He appealed to all “players” to take an overall view, especially since care and health are “communicating vessels”. It was suggested to the states that they interlink the planning logic if financing from a single source could not be implemented. In addition, the social insurance companies are required to develop a uniform catalog of services and conclude an overall contract with the medical profession. The minister also informed that there are now 50 primary care units in Austria; another 20 are in the pipeline. The minister was pleased that since the change in the legal basis, which reduced bureaucracy, there has been a real boom.
Proposals from the SPÖ and NEOS to finance health care and redesign financial equalization were postponed
With a view to the upcoming financial equalization negotiations, the SPÖ pushed for a so-called health care package worth at least half a billion euros to strengthen the outpatient sector. These funds will primarily be used to expand primary care units, set up multidisciplinary and developmental diagnostic outpatient clinics, and significantly increase the number of psychosocial treatment offerings. Furthermore, from the SPÖ’s point of view, it would be necessary to create a risk structure equalization between the individual health insurance companies, as is now the case in all surrounding countries, the applicants argued.
In general, MP Dietmar Keck (SPÖ) pointed out that the Social Security Organization Act initiated by the previous turquoise-blue government had created an underfunded ÖGK and that around €600 million would be withdrawn from health insurance by 2024. In addition, the reduction in the contribution rate for accident insurance will be financed at the expense of health insurance by reducing the lump sum from around €500 million to €140 million. In addition to a reversal of these measures, the SPÖ is also calling for the implementation of the promised billion for patients (€200 million each over a period of five years) in order to finally be able to further expand services (3315/A(E)).
The NEOS department head is also asked to develop a goal-oriented financial equalization logic for the next financial equalization period in the area of health and care (1338/A(E)). Instead of a politically agreed distribution key, MP Fiona Fiedler (NEOS) suggests controlling the health and care sector using three levers: via prevention measures, health and care planning and linking financial compensation payments to the achievement of targets. According to the applicant, possible goals for this could include the age structure, quality goals or the degree of distribution of the structured care programs. Both motions were postponed by a majority.
Teaching practices: Evaluation report draws positive conclusions and shows need for improvement in some areas
The first evaluation of the compulsory six-month teaching experience introduced in 2015 as part of training to become a general practitioner was largely positive. In his report (III-952 d.B.) the Ministry of Health cites, among other things, the increase in the practice of rotating doctors in private practices compared to pure hospital rotations, both in medical-technical terms and in dealing with patients. However, there is potential for improvement in the transfer of knowledge about organizational and business aspects of a general practitioner’s practice.
In general, those surveyed tended to rate the current duration of the teaching practice section as too short to accommodate all the training content. However, only some of those surveyed were in favor of extending the teaching practice period, and only if this would be linked to the possibility of a change of practice. Despite the positive assessments of a teaching practice by trainee doctors, the surveys showed that only four out of ten medical degree graduates want to pursue a professional career in general medicine. In general, the majority of young doctors prefer to work in group practices, primary care facilities or job-sharing models rather than establishing an individual practice as a family doctor.
Of the trainee doctors in a teaching practice, 87.2% of their training received a grade of “very good” or “good”, emphasized MP Martina Diesner-Wais (ÖVP).
The suggestions for improvement contained in the report should also be taken seriously, said Fiona Fiedler (NEOS), who referred, among other things, to the establishment of a mediation platform. One possibility would also be to set up teaching practices in shortage subjects.
The report was acknowledged with the votes of ÖVP, SPÖ, Greens and NEOS.
Report on social insurance prevention and health promotion measures
Prevention in the form of health promotion among the population is a major concern for the Austrian social insurance providers. Health and Social Affairs Minister Johannes Rauch emphasizes this in a report requested by the National Council in a resolution (III-980 d.B.) on the implementation of “preventive measures” that are prescribed in the General Social Insurance Act for insurance companies such as the Austrian Health Insurance Fund (ÖGK), the Insurance Company for Public Employees, Railways and Mining (BVAEB) or the Social Insurance for the Self-employed (SVS). In addition to the classic preventative measures taken by the public sector, such as cost support for legally defined vaccinations, the report lists initiatives to strengthen “health literacy” in the population.
As an example of the overall preventive examination contract concluded between social insurance and the Austrian Medical Association, the report describes not only colon cancer screening but also the breast cancer early detection program. The age limit for the core target group was raised in June 2023; This means that women between the ages of 46 and 75 now receive active invitations to be examined. Participation in the early detection program is still open to women over the age of 41.
It is basically good that a report is now available, admitted Fiona Fiedler (NEOS). However, she would have expected a more comprehensive study that was not just limited to exemplary lists. Although many people are willing to take precautionary measures, many do not know what exactly is available and where. As far as breast cancer screening is concerned, she would like to see men who have a specific genetic defect also be invited to take part.
From January next year, colon cancer screening will be implemented as a pilot project in three federal states, informed Federal Minister Johannes Rauch. Two examination methods (blood in the stool, colonoscopy) should also be available.
The report was acknowledged with the votes of the ÖVP, SPÖ and the Greens.
Corona report: EU was able to reduce delivery obligations for corona vaccines by 4.9 million doses
For the year 2023, the Federal Finance Act estimated a total of €400 million in cost reimbursement for the federal states and the AGES in connection with the Epidemic Act, with €431.55 million by the end of April (January and February €171.45 million, March and April 260.1 million) were incurred. The largest items include screening programs, compensation for loss of earnings, fees for epidemic doctors or examinations. The federal government is also providing special-purpose grants for certain expenses incurred by the states due to the COVID-19 crisis, for which, according to the BFG, €200 million has been earmarked this year. This emerges from the current monthly report from Health Minister Johannes Rauch in accordance with the COVID-19 Transparency Act, which was accepted by the ÖVP-Greens majority (III-972 d.B.).
In response to MPs’ questions, Minister Rauch stated that at the end of May 2023, in lengthy negotiations with BioNTech-Pfizer, the EU had achieved to reduce the delivery obligations of 9.8 million doses by 4.9 million doses. The remaining quantities will be distributed over the years 2023 (1.9 million), 2024 (1.4 million) and 2025 (1.6 million). He told MP Peter Wurm (FPÖ) that his department is assuming that this will work. 9.5 million doses from old stocks were passed on, and 10.3 million doses had to be disposed of because their expiry date was exceeded. As far as settlements for loss of earnings are concerned, 500,000 applications are currently still open. He told MP Fiona Fiedler (NEOS), who spoke about wastewater monitoring, that this gave a very good overview of infections, including respiratory diseases.
Opposition motions: From the lack of personnel in the health sector to improving trauma surgery care
The SPÖ sees a further urgent need for action on the issue of a shortage of doctors. Although the population is growing, the number of health insurance practices in Austria has been declining since 2010 and has fallen from 8,501 to 8,132. At the same time, there was a 40% increase in elective doctors over the same period, the Social Democrats show. Things aren’t looking much better in the hospitals either, especially since there will be a shortage of around 6,000 doctors by 2030 due to retirements. The SPÖ wants to start, among other things, with the admission criteria for studying medicine and with the number of study places, which in their opinion should be doubled. According to the SPÖ’s proposal, preference should be given to those applicants who, after training, commit to working in the public health system for a few years, primarily as family doctors in underserved regions, emphasized Verena Nussbaum (SPÖ). This would correspond to the German model of the rural doctor quota, which, in the opinion of the SPÖ, should also be introduced in Austria in an adapted form (3316/A(E)). It is also unacceptable that the proportion of private additional payments for medical services is now over 20%, explained Philip Kucher (SPÖ). ÖVP MP Josef Smolle pointed out that this proportion was declining and was 27% a few years ago.
MP Ralph Schallmeiner (Greens) was convinced that training in hospitals needed to be made much more attractive. The dissatisfaction expressed by many of those affected with the current system, such as the chain contracts in Vienna’s hospitals or the poor work-life balance, should be taken seriously.
According to Fiona Fiedler (NEOS), there are enough doctors in Austria. The real problem was the unattractive health insurance contracts, which urgently need to be changed.
A motion from the Freedom Party goes in a similar direction. Since the introduction of the EU Working Time Directive in 2012, conditions for doctors and health workers have taken a turn for the worse, said Gerhard Kaniak (FPÖ). The corona crisis and the government’s treatment of hospital employees contributed to the rest and led to many employees quitting, moving to other professions or being forced into retirement. The 6-point plan developed by the Freedom Party to solve the staff shortage addresses organizational, personnel and financial levels. The implementation of the following points is considered particularly necessary: the evaluation of personnel requirements at all levels of the healthcare system, more financial fairness for all employees in the healthcare system, de-bureaucratization and expansion of skills in the professional fields of the healthcare system, continued employment of older statutory health insurance physicians aged 70 and over and expansion of training, the introduction of a nationwide uniform scholarship system for vocational training and the integration of elective doctors into the health insurance system, including the lifting of the ban on dual employment. When it comes to working hours in the healthcare sector, what is needed above all is more planning security for employees with an improved work-life balance, emphasized Kaniak. It is also important to direct the flow of patients in the right direction, namely into local health care, in order to finally relieve the burden on hospitals (3342/A(E)).
The Freedom Party also criticizes the recently passed legal changes in the area of the primary care system, as in their opinion they would exacerbate the problems even further. It is to be feared that after the reform has been implemented, there will be fewer contract doctors available to the healthcare system, warns FPÖ MP Gerhard Kaniak. Care for the population can only be guaranteed if at least the move towards retirement and the switch to primary care units (PVE) is compensated for by filling vacant statutory health insurance contract positions and additional contract doctors are recruited for individual practices, group practices and PVEs. It would also be important to integrate elective doctors into the statutory health insurance system by awarding half and quarter contracts if vacancies cannot be filled otherwise (3518/A(E)).
The Freedom Party also sees imminent danger in trauma surgical care in Austria (3337/A(E)). FPÖ MP Gerhard Kaniak refers to an open letter from the relevant specialist society, which warns that the care of seriously injured people is on the verge of collapse. The problems ranged from dramatic personnel problems in hospitals, training gaps in the special subject of “orthopedics and traumatology” to the lack of implementation of so-called trauma networks in numerous federal states. It is therefore important to quickly implement these measures contained in the list of demands of the Austrian Society for Trauma Surgery (ÖGU), urges the FPÖ health spokesman. In addition, there is an urgent need to expand operating room capacity and make the hospital doctor profession more attractive.
Finally, Kaniak is calling for an amendment to the professional law of the higher medical-technical services (MTD) (3380/A(E)). This is “urgently” necessary because the MTD law, which has been in force for 30 years, no longer meets current requirements for the seven MTD professions (biomedical analysis, dietetics, occupational therapy, speech therapy, orthoptics, physiotherapy and radiology technology).
During the vote, all motions were postponed with the votes of the ÖVP and the Greens.
SPÖ for rapid measures to increase willingness to vaccinate and NEOS proposal for vaccinations in pharmacies
On the subject of vaccination, there were applications from both the SPÖ and NEOS, both of which were postponed. The Social Democratic health spokesman Philip Kucher pointed out that Austria is sometimes considerably behind comparable countries when it comes to vaccination rates on average across the OECD (2705/A(E)). There were massive declines, especially in child vaccinations, where declines of up to 68% (measles, mumps, rubella) were recorded from 2019 to 2021. International examples show that what is needed above all is low-threshold access and comprehensive, free vaccination programs. The SPÖ is therefore proposing a package of measures that includes the following points: adoption of the national vaccination plan as a mandatory service in the service portfolio of statutory health insurance, inclusion of a mandatory consultation on child vaccinations in the mother-child pass, implementation of a broad-based information offensive, bonus payments to parents for Completed vaccination series for children, carrying out vaccinations in pharmacies, increasing school vaccinations and rapid expansion of the electronic vaccination certificate including the addition of a reminder function.
Carrying out vaccinations in pharmacies is also a long-standing demand of NEOS. In what is now the eighth attempt, they are proposing that standard vaccinations in particular, such as against TBE or influenza, should also be administered by pharmacists in the future (669/A(E)). Fiona Fiedler (NEOS) showed that over 2,000 pharmacists have now been trained in this. She was happy that there was movement on the matter after Minister Rauch signaled support for the issue before the summer, but client interests had obviously prevailed again. Gerhard Kaniak (FPÖ) also referred to numerous European countries where vaccinations are allowed in pharmacies. In Bavaria alone, 600,000 people were vaccinated against flu in pharmacies last year. (Health Committee continued) sue
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