Wild dispute over money

Healthcare reform on the brink

Health Minister Rauch (left) and Vienna's City Councillor for Health Hacker are always at loggerheads.

(Bild: APA, Krone KREATIV)

Can the financial equalization between the federal and state governments still fail? Negotiations on the implementation of the healthcare reform have come to a standstill. The federal states have given the federal government an ultimatum until the end of June. As a result, Health Minister Johannes Rauch (Greens) has unexpectedly called a special meeting of the Target Steering Commission for tomorrow Friday.

Some federal states feel provoked by Rauch and suspect an election campaign maneuver, as the minister is planning a press conference after the meeting without prior consultation. "This is a strange approach. The minister obviously wants to be celebrated," said an insider to "Krone". What's more: ÖGK chairman Andreas Huss, who is leading the negotiations for the health insurance fund, is currently on vacation.

Ministry plays down conflict
The ministry is trying to play down the conflict. "The goal tomorrow is to implement the healthcare reform." The sums have already been fixed with the financial equalization, now it is a matter of "creating a set of rules: How can the funds be used, which projects are counted, what evidence must be provided about the use of funds, etc.," the department said in response to a question from the "Krone".

Five billion will flow in the coming years
It is about one billion euros per year over the next five years. At the last meeting of the Federal Target Control Commission at the end of April, at which measures should have been fixed, all points were postponed.

There are issues in several areas: Among other things, an additional 90 million euros have been agreed for vaccinations. However, according to the federal states, the federal government wants to include the coronavirus and influenza vaccinations, which were previously paid for by the federal government, in these sums. In future, these vaccinations would be paid for equally by the federal government, the federal states and the health insurance fund. This would save the federal government money. "However, we want to use the money to make all currently recommended vaccinations, which are subject to a charge, free of charge," says the city of Vienna, for example.

States want additional money for vaccinations.

(Bild: stock.adobe.com/Alessandro Guerriero)

Shifting costs onto others?
There are also discussions about the use of MRIs. Although the number of devices in Austria is high, the number of examinations is even higher. With 159 examinations per 1000 inhabitants per year, Austria is the European leader. Between 2015 and 2021, the number of MRI examinations in hospitals remained de facto unchanged. In the private practice sector, it has increased by 60 percent.

ÖGK Chairman Huss wants to make more intensive use of the equipment in hospitals. This in turn would mean more costs for the federal states, as they finance the hospitals. Consequently, the provinces are insisting on more MRIs financed by the health insurance funds. In many private practices, these would stand around unused. The federal states reject considerations by the health insurance funds to make MRI examinations subject to compulsory medical examination.

Austria is the European leader in medical "photography".

(Bild: weerayut/stock.adobe.com)

Time is pressing due to the upcoming National Council elections
When implementing the reform, the focus should generally be on expanding the services offered by statutory health insurance physicians and primary care units. The flow of payments is linked to the implementation of the reforms. If there is no agreement, there could be no money for the federal states. Time is pressing, as the National Council elections at the end of September and the subsequent formation of a government will make it difficult to reach a decision this year.

Rauch admits failure of care reform
The current dispute shows once again how difficult it is for Austria to implement reforms in some areas due to federalism. The situation is similar in the care sector. Rauch recently admitted the failure of the care reform and called for a bundling of competencies at federal level. "We have the central problem that we have not managed to achieve joint funding in a fragmented system. That is correct. We have now come up with a crutch, namely financial equalization. But if you ask me, the next government will probably have to discuss whether we should finally create a federal state reform," said Rauch.