Analysis of the ‘reformpool’-activity in Austria: is the challenge met?

Aim of the article: The purpose of our study is to analyse the activities initiated by the foundation of the reformpools on the regional level. We wanted to see not only what projects have emerged from these funds, but also how the incentives of this special way of funding influence the activity and what overall impact can be expected on health services delivery in the future. (from the abstract

Regional medical practice variation in high-cost healthcare services: evidence from diagnostic imaging in Austria

Magnetic resonance imaging (MRI) is a popular yet cost-intensive diagnostic measure whose strengths compared to other medical imaging technologies have led to increased application. But the benefits of aggressive testing are doubtful. The comparatively high MRI usage in Austria in combination with substantial regional variation has hence become a concern for its policy makers. We use a set of routine healthcare data on outpatient MRI service consumption of Austrian patients between Q3-2015 and Q2-2016 on the district level to investigate the extent of medical practice variation in a two-step statistical analysis combining multivariate regression models and Blinder–Oaxaca decomposition. District-level MRI exam rates per 1.000 inhabitants range from 52.38 to 128.69. Controlling for a set of regional characteristics in a multivariate regression model, we identify payer autonomy in regulating access to MRI scans as the biggest contributor to regional variation. Nevertheless, the statistical decomposition highlights that more than 70% of the regional variation remains unexplained by differences between the observable district characteristics. In the absence of epidemiological explanations, the substantial regional medical practice variation calls the efficiency of resource deployment into question

When to end a lock down? How fast must vaccination campaigns proceed in order to keep health costs in check?

We propose a simple rule of thumb for countries which have embarked on a vaccination campaign while still facing the need to keep non-pharmaceutical interventions (NPI) in place because of the ongoing spread of SARS-CoV-2. If the aim is to keep the death rate from increasing, NPIs can be loosened when it is possible to vaccinate more than twice the growth rate of new cases. If the aim is to keep the pressure on hospitals under control, the vaccination rate has to be about four times higher. These simple rules can be derived from the observation that the risk of death or a severe course requiring hospitalization from a COVID-19 infection increases exponentially with age and that the sizes of age cohorts decrease linearly at the top of the population pyramid. Protecting the over 60-year-olds, which constitute approximately one-quarter of the population in Europe (and most OECD countries), reduces the potential loss of life by 95 percent

Policy implications of heterogeneous demand reactions to changes in cost-sharing: patient-level evidence from Austria

Cost-sharing is a prominent tool in many healthcare systems, both for raising revenue and steering patient behaviour. Although the effect of cost-sharing on demand for healthcare services has been heavily studied in the literature, researchers often apply a macro-perspective to these issues, opening the door for policy makers to the fallacy of assuming uniform demand reactions across a spectrum of different forms of treatments and diagnostic procedures. We use a simple classification system to categorize 11 such healthcare services along the dimensions of urgency and price to estimate patients’ (anticipatory) demand reactions to a reduction in the co-insurance rate by a sickness fund in the Austrian social health insurance system. We use a two-stage study design combining matching and two-way fixed effects difference-in-differences estimation. Our results highlight how an overall joint estimate of an average increase in healthcare service utilization (0.8%) across all healthcare services can be driven by healthcare services that are deferrable (+1%), comparatively costly (+1.4%) or both (+1.6%) and for which patients also postponed their consumption until after the cost-sharing reduction. In contrast, we do not find a clear demand reaction for inexpensive or urgent services. The detailed analysis of the demand reaction for each individual healthcare service further illustrates their heterogeneity. We show that even comparatively minor changes to the costs borne by patients may already evoke tangible (anticipatory) demand reactions. Our findings help policy makers better understand the implications of heterogeneous demand reactions across healthcare services for using cost-sharing as a policy tool

Selbstbehalte in der Sozialversicherung. Einsatz als Steuerungs- und Finanzierungsinstrument. Teilbericht Modul I: Qualitative Analyse

In vielen Gesundheitssystemen spielen Selbstbehalte eine wichtige Rolle. So werden sie dazu genutzt die Inanspruchnahme von Gesundheitsleistungen der PatientInnen zu steuern, oder einfach als Mechanismus für das Lukrieren zusätzlicher finanzieller Mittel eingesetzt. Aus Sicht der ökonomischen Theorie gibt es sowohl Gründe, die für den Einsatz von Selbstbehalten, aber auch Gründe, die dagegen sprechen. Der vorliegende Projektbericht fasst die wichtigsten theoretischen Argumente und aktuelle empirische Erkenntnisse zusammen. Damit können der aktuelle Einsatz von Selbstbehalten im österreichischen Gesundheitssystem bewertet, und mögliche Perspektiven für Reformen in Richtung höher Effektivität benannt werden. Vor allem der Umstand, dass in Österreich mehrere unterschiedliche Selbstbehalteregime über die Sozialversicherungsträger hinweg bestehen, ist aus dem Blickwinkel des gleichen Zugangs zu medizinischen Leistungen kritisch zu sehen. Verbesserungen können durch eine gestaffelte und evidenzbasierte Ausgestaltung von Selbstbehalten erreicht werden. Dadurch können sozial schwächere PatientInnen besser vor negativen Auswirkungen von Selbstbehalten geschützt, und PatientInnen allgemein in Richtung notwendiger (evidenzbasierter) Gesundheitsleistungen gelenkt werden. In many healthcare systems around the globe, cost sharing maintains a key role. It can be used as a tool to influence patients’ patterns of healthcare service consumption, or simply as a revenue raising mechanism. From an economic point of view, there are both arguments in favour, but also against applying cost sharing in practice. This project report summarises the major economic arguments and recent empirical evidence. This is used to assess the current state of cost sharing in the Austrian healthcare system and to highlight possibilities for policy action to steer the use of cost sharing towards higher effectivity. We find that the multitude of different cost sharing schemes across social health insurance provides in Austria is problematic in terms of equity in access to care. Improvements can be made along the lines of staggered cost sharing to more effectively protect vulnerable patients, and value-based cost sharing to nudge patients towards evidence-based medical service and thus reduce the gap between necessary and merely desired treatment

Maßnahmen zur Teilnahmeerhöhung am Disease Management Programm „Therapie Aktiv“

In Bezug auf das österreichische Disease-Management-Programm für Diabetes „Therapie Aktiv – Diabetes im Griff“ werden die Gründe für die aktuelle Teilnahmerate von 23 Prozent an DMP auf Seiten der Patient*innen und Ärzt*innen ergründet sowie Anreize zur Erhöhung der Anzahl der Teilnehmer*innen beleuchtet

Three Approaches to Handling the COVID-19 Crisis in Federal Countries: Germany, Austria, and Switzerland

Despite their geographical and cultural proximity, Germany, Austria, and Switzerland can teach very different lessons on how to handle the COVID-19 pandemic. Timing and severity of outbreaks were fairly similar in Germany and Austria (see Figures 17.1 through 17.3), whereas Switzerland faced a higher infection rate at the peak of the crisis (although far from rates in France or Italy). Response measures eventually taken by the three countries were not too different, either, but how decisions were made and subsequently communicated to the public varied considerably. In all three countries, containment measures were met by a high level of adherence within the population, as mobility indices illustrate (see Figures 17.1 through 17.3). As a result, the three countries fared well in reducing transmission rates and never came close to reaching capacity limits in their health systems. This chapter aims to examine the outbreak responses of the three countries and give insight into the dynamics and rationales behind these responses