Austria's Court of Audit Proposes Major Healthcare System Overhaul by 2040

In terms of financing, the report criticizes the current system as problematic and suggests adopting a 'money follows performance' approach. It also recommends examining socially acceptable ways to integrate private funds into the public system, potentially through patient co-payments.

Financing Reforms

The Court highlights that Austria's public health expenditures reached approximately €44 billion in 2024, warning that continuing current financing methods risks quality and performance deficits. 'Only structural change can secure needs-based care in the public healthcare system,' the report states bluntly.

A significant focus is placed on improving data utilization and quality measurement. The report notes that central information like diagnoses from outpatient care has often been unavailable or insufficient, and the electronic health record system ELGA has fallen short of its technical potential.

The Court proposes developing a transformation pathway with milestones on both financing and performance sides until 2040. 'By 2028, there is a window of opportunity for preparatory measures,' the paper states, urging political decision-makers to show more courage in driving reforms.

Data and Quality Improvements

In parallel developments, Saxony-Anhalt is adapting its hospital planning to federal reforms, with 44 hospitals at 53 locations. The new approach emphasizes hospitals specializing in services where they have adequate staff, technology, and experience, rather than trying to offer 'a little bit of everything.'

Meanwhile, in North Rhine-Westphalia, Germany, medical facilities in Goch and Kevelaer will close by 2031/2032, replaced by expanded hospitals in Kleve and Geldern. The €300 million project, partly funded by the Catholic Karl-Leisner-Trägergesellschaft (KKLE), aims to become the largest hospital promotion project in the region.

The reorganization will see patients from Wilhelm-Anton-Hospital in Goch moved to Kleve and those from Marienhospital Kevelaer relocated to Geldern. While specialist departments will move, ambulatory care will continue at the original locations.

Regional Hospital Restructuring

KKLE expects the changes to create new jobs while maintaining existing workforce levels. The upgraded hospitals in Kleve and Geldern will provide higher-level emergency care (Level 3), compared to the current Level 2 in Kleve and Level 1 elsewhere in the district.

The reforms aim to reduce the current situation where 30% of district residents seek treatment outside the area due to lacking specialties. Future capabilities will include stroke treatment and a planned thoracic surgery department in Kleve.

The Kleve district council is currently reviewing the transformation plans, with a decision expected by late July. If approved, funding allocation will follow to implement what is seen as a crucial step in improving regional medical care, particularly in emergency medicine.

Employee representative Bruni Berns from Goch expressed confidence in the transition: 'We at Wilhelm Anton Hospital in Goch are a great team, giving our all here and will continue to do so in Kleve when we eventually move.'

Political Context and Challenges

The Austrian Court of Audit's recommendations come as the country's three-party coalition government has committed to a complete overhaul of what it describes as an expensive and often inefficient healthcare system through its 'reform partnership.'

The 15 proposals are grouped into three action areas: developing a target picture for care structures, aligning financing with this structure, and improving governance through better data use and clearer responsibilities.

The report stresses that current political efforts are insufficient, noting that while several reform projects are underway, 'a directional decision is necessary that sets a longer-term goal.' It points to sharply declining efficiency in hospitals, where costs per patient day in state-funded institutions rose 92% between 2014-2024 while patient days dropped 19%.

Among specific suggestions are improving patient orientation through better wait time management for time-critical treatments and initial information services. The Court also sees the mandatory diagnosis coding for office-based physicians starting in 2026 as an opportunity to enhance planning.

The report concludes with a call for open communication about necessary changes: 'Politics should proactively communicate changed expectations to patients, such as the guiding principle of digital before outpatient before inpatient care.'