Austrian Health Insurance Fund Chief: Specialist Centers Face Hurdles, Reform Aims to Shift Care

Austria's ambitious healthcare reform, centered on establishing specialist centers, is encountering significant hurdles, primarily stemming from the medical establishment's staunch defense of the individual physician system. Andreas Huss, head of the Austrian Health Insurance Fund (ÖGK), noted that while a few centers have opened, progress has been slow because the Ärztekammer (Medical Chamber) has not actively supported the initiative.

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We have opened a few, in Vienna, in Graz, in Carinthia. But the idea would be that doctors also act as entrepreneurs. But since the Ärztekammer very strictly defends the single-doctor system and has not engaged, little has come of it.

Thomas Czypionka, a health economist, suggested the ÖGK's lack of interest was due to specialist centers relieving hospitals, which are funded by the federal states. Huss partially agreed, explaining that in many regions, the Medical Chamber's veto power, only recently removed by the 2024 Financial Adjustment, had blocked progress. Even with this obstacle gone, not all federal states have shown enthusiasm. Vienna's Diabeteszentrum, for example, only materialized through a joint commitment from the city and ÖGK to fund it.

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He is only partially right. In many federal states, we would have failed due to the Ärztekammer's veto anyway. This veto option was only eliminated with the Financial Adjustment 2024. Only after that did it become possible to decide on such centers with the states in the Regional Structure Plan. Although not all federal states have shown interest so far.

Looking ahead, Huss envisions multiple operational models for these centers. These include private physician-led practices, joint ventures between ÖGK and other social insurance bodies like SVS and BVAEB, or even public-private partnerships with federal states. The federal government has pledged initial funding for these centers, which Huss anticipates will last at least ten years, with long-term financing expected from social insurance and the states.

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I expect at least ten years.

The funding ratio between social insurance and states is typically 50:50, but can adjust based on the degree to which centers alleviate hospital burdens. For instance, if centers perform outpatient surgeries, increasing hospital relief, states would contribute more. The overarching goal of the reform is to prioritize outpatient care over inpatient treatment, a move Huss believes benefits the entire health system. However, a key question remains about how costs will be managed, as the ÖGK currently pays eight billion euros to hospitals, a sum that will eventually need to be redirected to ambulatory care.

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The social insurance pays eight billion euros to the hospitals, at some point the money will have to be redirected from the hospitals to outpatient care.