Cross-Section Analysis of Health Spending with Special Regard to Trends in Austria

During the 90s the increase in health spending which compared to the overall growth had taken place at a rather rapid pace experienced a worldwide slow-down. In relation to overall economic growth and the expansion of other countries' health care systems, Austria's system grew below average- a fact which holds particularly true for the years between 1990 and 1997. This development may largely be due to a constant consolidation of budget and relatively high prices for private households which are possibly overestimated, however. This overestimation of prices are probably caused by unascertained productivity improvements which may have occurred in the acute care sectors. Within our observation period of 16 years, the private households' expenditure reached a peak with spending on physician services experiencing the fastest increase. Although overestimated, the high prices in the health sector together with sharply rising consumption expenditure on health care constitute an increased burden on households.Oesterreich, Health Expenditures, Cross Section, Estimation of, European Union, Austria

HEALTH SYSTEM WATCH SPRING/1999: CROSS-SECTION ANALYSIS OF HEALTH SPENDING WITH SPECIAL REGARD TO TRENDS IN AUSTRIA

The richer a country, the higher its expenditure on health care. The increase in health spending which compared to the overall growth had taken place at a rather rapid pace experienced a worldwide slow-down during the 90s. In relation to overall economic growth and the expansion of other countries’ health care systems, Austria’s system grew below average- a fact which holds particularly true for the years between 1990 and 1997. This development may largely be due to a constant consolidation of budget, relatively high prices for private households, which, however, are possibly overestimated and still unascertained but highly probable improvements in productivity in the main fields of health care. Within our observation period of 16 years, the privat households’ expenditure reached a peak with private health spending experiencing the quickest increase. Although overestimated, these relatively high prices together with a sharply rising consumption expenditure on health care constitute an increased burden on private households. While social insurance companies in their function as bulk purchasers have had the power to reject excessive prices, private customers were charged above average during the last few years. This development has to be closely scrutinized in order to ensure public welfare and the maintenance of a social health care system in future.health economics

MOJ Public Health Personalized Medicine Takes Foresight and Smart Public Policies

Abstract Governments and health care payers everywhere seek ways how to design public funding policies for high-cost drugs, which are increasingly personalized and often only effective in small population groups or sub-groups. Access to drugs is usually preceded by health technology assessment. Challenges for access to effective drugs at the patient level remain, as the current reimbursement environment is not ready to encompass the complexity of Personalized Medicine. A high level of uncertainty remains as to how, for whom and which type of Personalized Medicine should unfold in the future. Foresight modeling may come into play here. Foresight is a systematic approach to look into the longer-term future of science and technologies and their potential impacts on society. It aims at identifying research and development areas likely to generate future economic, environmental and social benefits

Cross-Section Analysis of Health Spending with Special Regard to Trends in Austria

Abstract: During the 90s the increase in health spending which compared to the overall growth had taken place at a rather rapid pace experienced a worldwide slow-down. In relation to overall economic growth and the expansion of other countries' health care systems, Austria's system grew below average- a fact which holds particularly true for the years between 1990 and 1997. This development may largely be due to a constant consolidation of budget and relatively high prices for private households which are possibly overestimated, however. This overestimation of prices are probably caused by unascertained productivity improvements which may have occurred in the acute care sectors. Within our observation period of 16 years, the private households' expenditure reached a peak with spending on physician services experiencing the fastest increase. Although overestimated, the high prices in the health sector together with sharply rising consumption expenditure on health care constitute an increased burden on households.

Health system performance assessment landscape at the EU level: a structured synthesis of actors and actions

Background: Many policy makers and other stakeholders in the EU have expressed interest in better understanding the performance of their own health systems to identify opportunities for improvement in effectiveness, efficiency and equity. Health system performance assessment (HSPA) has received considerable attention at EU level as an instrument to improve transparency and accountability. This is equally important for population health and sustainable health spending. The goal of this paper is to synthesise and map the current state and developments in the field of HSPA relevant in the EU context and by this aid the navigation in the growing HSPA system, understand the available tools and identify opportunities for improvement. Methods: Structured synthesis of the literature on initiatives in the field of HSPA at EU level was carried out. Key literature was identified by a focused review performed between October 2015 and June 2016 on websites of key institutions including the EU, OECD and WHO and Google engine. We used six predefined criteria for identifying key literature. Identified initiatives were classified according to analytical and conceptual output or whether a guiding or advisory role was resumed. A visual map of the relationships between the different actions and actors involved in HSPA was developed. In addition, expert opinion was sought to refine the map. Results: We identified a total of 64 relevant initiatives and their relationships in the field of HSPA. These include institutions such as the European Commission (73%), European Council (8%), OECD (9%) and WHO-EUR (9%). 24 initiatives produced analytical outputs, four developed conceptual outputs and six had a guiding role. The role of the EU in HSPA and collaboration with other key actors have intensified considerably since the adoption of the EU Health Strategy in 2013. The EU HSPA landscape is complex with seemingly few streamlining activities. Conclusions: Knowledge transfer and exchange of expertise are key to HSPA. While cooperation between the key actors have intensified recently and clearly reflect the "Health in all Policies" (HIAP) approach, there is considerable room for improved streamlining activities to share knowledge and avoid overlapping efforts, especially within the European Commission

Das Gesundheitswesen in Österreich: neue Trends und neue Fakten

'Die Beschäftigung im Gesundheitswesen wächst erheblich schneller als die Gesamtbeschäftigung, aber auch schneller als jene im Dienstleistungssektor. Und dies ausnahmslos in allen Bundesländern. Das Gesundheitswesen ist eine 'Wachstumsbranche' und bleibt damit ein wichtiger Arbeitsmarkt für Frauen. Österreichdurchschnittlich waren 1994 knapp vier mal soviele Frauen im Gesundheitswesen beschäftigt als im Dienstleistungssektor und mehr als fünf mal soviele wie bei den Aktiv-Beschäftigten insgesamt. In der Gegenüberstellung mit 11 hochentwickelten OECD-Staaten lag Österreich mit dem Indikator Bruttoinlandsprodukt pro Kopf an fünfter Stelle. Mit dem Indikator Gesundheitsausgaben bezog Österreich 1995 das untere Mittelfeld. Bei der Gegenüberstellung des Gesundheitszustandes, gemessen an der Verringerung verlorener Lebensjahre lag Österreich im Spitzenfeld. Die aggregierte Performance des österreichischen Gesundheitswesens, gemessen an der Verringerung des 'Sterbens vor der Zeit', ist vergleichsweise sehr gut. Ferner weist die stetige Verringerung der Verweildauer bei gleichzeitig höheren Aufnahmeraten und höheren Fallzahlen pro Bett auf Produktivitätsverbesserungen im stationären Sektor hin. Darüber hinaus ist die Verringerung des potentiell vermeidbaren 'Sterbens vor der Zeit' aus qualitativer Sicht ein entscheidender Produktivitätsfortschritt.' (Autorenreferat)'Between 1986 and 1994 employment in the health sector in Austria has grown abundantly faster than in the whole economy and also faster than in the service sector. The health sector is an important labour market for women and as a growth sector it remains to supply fair employment opportunities for women. In 1994 the proportion of women working in the health field was about fourfold compared to the sex ratio in the service sector and more than fivefold compared to total employment. Compared to 11 highly developed OECD-countries Austria's per capita income in 1994 happened to be upon the highest. In contrasting the performance of the Austrian health system it can be shown that the GDP-share of health expenditures is less than average. Furthermore, taking outcome into account, premature death - measured in the potential years life lost - is been lowest in Austria. Hence, the aggregate performance of the Austrian health system is comparatively very good. In addition, the steady decrease of the average length of stay accompained by increasing admission rates and turnover rates indicates productivity improvements in the hospital sector. Moreover, to abate premature death is a decisive productivity gain, consistent with quality improvements.' (author's abstract)

Improved health system performance through better care coordination

This report attempts to assess whether – and to what degree – better care coordination can improve health system performance in terms of quality and cost-efficiency. See also the annex (PDF) to this paper

Die Reform des Gesundheitswesens in der Slowakei: Pflichtprogramm oder Kür? - Schwerpunktthema: Arztgebühr in Österreich - Wie viel bringt sie, und wer zahlt sie?

Die Reform des Gesundheitswesens in der Slowakei: Pflichtprogramm oder Kür? Die Gesundheitsversorgung in der Slowakei ist seit den 90er Jahren in einer Dauerkrise, die sich in unsolider Zahlungsmoral, in mangelnder Qualität und in der fehlenden sozialen Kohäsion ausdrückt. Vor diesem Hintergrund ist die im Oktober 2004 verabschiedete Reform notwendig gewesen. Ingesamt verfolgt die liberal-konservative Regierung dabei einen marktorientierten Ansatz und legt ein starkes Augenmerk auf Deregulierung, Privatisierung, Dezentralisierung, mehr Wettbewerb und die Mobilisierung von privaten Ressourcen. Ob die Slowakei auch bei Gesundheitsreformen ein Vorreiter für Europa wird, hängt jedoch in erster Linie davon ab, ob es gelingt, das Vertrauen der PatientInnen und der SteuerzahlerInnen, aber auch der Leistungserbringer in die neu geschaffenen Institutionen zu stärken. Dies kann nur über die Verbesserung der sozialen Kohäsion erzielt werden. Erste Schritte dafür sind eingeleitet. Arztgebühr in Österreich: Wie viel bringt sie, und wer zahlt sie? Die Einnahmen aus einer „Arztgebühr“ könnten kurzfristig das Kassendefizit in Österreich ausgleichen. Je niedriger das Bildungsniveau, desto stärker wären sowohl Frauen als auch Männer von den Arztgebühren betroffen. Frauen, deren Medianeinkommen etwa um ein Drittel unter jenem der Männer liegt, müssten jedoch in jeder Bildungsstufe, relativ zu ihrem zur Verfügung stehenden Einkommen, noch mehr für Selbstbehalte aufwenden als Männer. Die unterschiedliche Betroffenheit weist auf die Schwierigkeiten hin, Selbstbehalte angepasst an die finanzielle Leistungsfähigkeit auszugestalten. Bei einer sozial verträglichen Ausgestaltung müssen sowohl administrative Kosten als auch ein verringertes Einnahmevolumen berücksichtigt werden. Zudem sollten für sozial verträgliche Regelungen Haushalts- und nicht Individualeinkommen die Bezugsgröße darstellen, was den Administrationsaufwand weiter erhöht

Langzeitversorgung in der EU: Wenig Chance für "ambulant vor stationär"? - Schwerpunktthema: Internationale Reformen in der Langzeitversorgung

Wenig Chance für „ambulant vor stationär“? Die unterschiedliche Grenzziehung in der Arbeitsteilung zwischen Akut- und Langzeitversorgung spiegelt sich in einem Trade-off zwischen Pflege- und Akutbetten wieder. In einigen neuen EU-Mitgliedsländern, aber auch in Österreich und Belgien, stehen einer hohen Anzahl von Akutbetten deutlich weniger Pflegebetten gegenüber. In den nordischen Ländern werden relativ mehr Pflegebetten als Akutbetten angeboten. Diese Unterschiede erklären sich teilweise aus der unterschiedlichen Bedeutung der Familie bzw. des Staates in der Wahrnehmung der Versorgung. Typischerweise liegen die Ursachen für einen länger als medizinisch nötigen Verbleib im Krankenhaus bei älteren PatientInnen im weiter bestehenden Pflegebedarf bei fehlenden Kapazitäten zu ihrer Unterbringung. Das Problembewusstsein für diese Fehlallokationen dürfte jedoch in allen Ländern gestiegen sein. Beim Ausbau von ambulanten Pflegekapazitäten müssen aber auch die Möglichkeiten häuslicher Unterstützung und die zu erwartende Entwicklung der Schwere der Pflegebedürftigkeit bedacht werden. Internationale Reformen der Langzeitversorgung Seit Anfang der 90er Jahre waren einige Länder bestrebt, durch einen Auf- und Ausbau einen ähnlich guten und bevölkerungsumfassend organisierten Zugang zu Langzeitpflege zu schaffen wie er für Akutbehandlungen meist bereits bestand. In manchen Ländern mussten die institutionellen Voraussetzungen aber erst geschaffen werden, wie die Pflegeversicherungen in Deutschland und Japan oder das steuerfinanzierte Pflegegeld in Österreich. In den meisten betrachteten Ländern wurden auch Maßnahmen zur Qualitätsverbesserung gesetzt. Zu diesen Maßnahmen zählten Ausbildungsvorschriften, Behandlungsstandards und -richtlinien sowie die Errichtung von Institutionen zur Erarbeitung und Durchsetzung dieser Qualitätsstandards

Characteristics and trends in required home care by GPs in Austria: diseases and functional status of patients

BACKGROUND: Almost all societies carry responsibility towards patients who require continuous medical care at home. In many health systems the general practitioner cooperates with community based services of home care and coordinates all medical and non medical activities. In Austria the general practitioner together and in cooperation with relatives of the patient and professional organisations usually takes on this task by visiting his patients. This study was carried out to identify diseases that need home care and to describe the functional profile of home care patients in eastern Austria. METHODS: Cross sectional observational study with 17 GP practices participating during 2 study periods in 1997 and in 2004 in eastern Austria. Each GP identified patients requiring home care and assessed their underlying diseases and functional status by filling in a questionnaire personally after an encounter. Patients in nursing homes were excluded. Statistical tests used were t-tests, contingency tables, nonparametric Wilcoxon signed rank sum test and Fisher-combination test. RESULTS: Patients with degenerative diseases of the central nervous system (65%) caused by Alzheimer's disease and cerebrovascular occlusive disease and patients with degenerative diseases of the skeletal system (53%) were the largest groups among the 198 (1997) and 261 (2004) home care cases of the 11 (1997) and 13 (2004) practices. Malignant diseases in a terminal state constituted only 5% of the cases. More than two thirds of all cases were female with an average age of 80 years. Slightly more than 70% of the patients were at least partially mobile. CONCLUSION: Home care and home visits for patients with degenerative diseases of the central nervous and skeletal system are important elements of GP's work. Further research should therefore focus on effective methods of training and rehabilitation to better the mental and physical status of patients living in their private homes