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Health Care Services
Outpatient medical care
The outpatient medical care of the Austrian population is in the hands of 18,025 (status: December 31, 2004) registered general practitioners (i.e. doctors of general medicine) and specialists (including dentists) who are mainly in private practice. In addition to conducting their individual practice, medical doctors in private practice are permitted (in accordance with an amendment to the 2001 Medical Practitioners Act) the joint use of consulting rooms or medical equipment within a group practice licensed as an independent medical care provider.
The majority of doctors in private practice have a contract with one or more social insurers. The reason these contracts are so important for doctors is because approximately 98 percent of the population is covered by social health insurance.
The basis of the contractual relationships between doctors and public health insurance funds is formed by comprehensive agreements which are concluded between the Main Associations of Austrian Social Security Institutions and the provincial - level Medical Chambers. Based on these comprehensive agreements, an individual contract is concluded between the individual doctor and the respective insurance institution. Rules governing remuneration vary. In practice there is a mixed system which provides both flat rate fees as well as compensation for individual services rendered.
Primary medical care is provided by the 6,221 general practitioners (family doctors), who should be the first contact in case of illness. If specialised examinations or treatments should be necessary, the general practitioner refers the patient to a specialist in this field or to an outpatient clinic.
Doctors and outpatient clinics charge their medical services to the health boards by means of a “health card” called the “E-card”. The “E-card” which was distributed over the course of 2005 to all those health-insured and their entitled dependents, is the key for access to health care services. This health card stores administrative data such as one’s name, academic tile and insurance information. The card’s back side functions as one’s European insurance card. This replaced the foreign patient certificate (E 111). Since the E-card is equipped with a digital signature function, it can simultaneously used as a citizen’s cards in the sense of E-government electronic administration. A yearly fee of ten Euros is charged for the health card.
Hospitals
More than two-thirds of all Austrian hospital beds (70.3 percent) are maintained by 133 public hospitals. In addition, there are 27 private hospitals (having 7.8 percent of the beds). The total of non-profit-making hospitals amounts to 160 (58.8 percent having 78.1 percent of the beds).
The Austrian territory is characterised by a large number of small hospitals. In late 2003, 61.4 percent of all hospitals had fewer than 200 beds, thus providing only 26.3 percent of total beds; 40 percent of them had fewer than 100 beds (5.1 percent of the total provided). 75 hospitals comprising 31.7 percent of all beds belonged to the 200-500 bed category. 21 hospitals between 500 and just under 1,000 beds contained a further 22.7 percent of Austrian hospital beds. Including the university clinics, there were nine hospitals with 1,000 and more beds, and these amounted all together to 19.3 percent of all beds provided.
Electronic health file and e-prescription
In the agreement according to Federal Constitution Article 15a, the contract parties agreed on the priority of conceiving and introducing an electronic health file (ELGA) and electronic prescriptions. In a first stage, the content plus the legal, technological and socioeconomic issues involved are being clarified in a feasibility study, from which the structure and concrete implementation measures will be derived.
A broad–based discussion process is to be initiated with regard to data protection law. The efforts of the Federal Ministry of Health, Family and Youth (BMGF) are directed towards the conception of a service–orientated technological and organizational infrastructure which is in accordance with the available standards and adapted to the requirements of the Austrian health care system. In order to facilitate the medium – and long-term planning of the detailed measures required and to ensure financial feasibility, a model is being developed which has to be harmonized with the national eHealth strategy currently being conceived.
Increased efficiency and qualitative improvements for the benefit of patients are expected from the ePrescription. These can stem from the linking of databases on medicines and their affects and the resulting extended basis for advice. In a first stage, implementation options are being drawn up which will then be evaluated from an economic perspective, thus broadening the basis for decisions on the specific design of the structure.
In connection with activities at European level, against which the progress of technological development in the health care system is measured, the ministry intends to establish an information management system which essentially includes the following elements with the health care system:
the establishment of an infrastructure reporting system
the economic evaluation of technology projects
an evaluation of the social effects of the use of technology.
In an initial stage, the establishment of the infrastructure reporting system will be tackled. The BMGF has set up a platform in cooperation with a private organisation which is designed to facilitate discussions and the exchange of views, but also the drawing up of recommendations for concrete activities. It is accessible for all stakeholders in the health care system and also for companies operating in this sector. The primary objectives of this eHealth initiative is to focus previously isolated knowledge and to lay down the basic conditions, demands and contents of a national eHealth strategy as defined by the eHealth Action Plan.
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