Austria's Court of Audit Proposes Major Healthcare Reform by 2040

The proposals stem from the Court's audits over recent years and are divided into three main areas: care structures, financing, and governance. With public health expenditures projected to reach €44 billion in 2024, the report highlights growing inefficiencies in the system.

One key recommendation is to clearly define leadership in the reform process. Kraker noted that past reform attempts failed due to lack of agreement among various stakeholders, including federal, state, and local governments as well as social insurance institutions.

Key Reform Proposals

The Court proposes a performance-based financing model under the principle 'money follows performance.' It suggests reviewing doctors' salaries and medication costs, which have risen faster than general economic growth in recent decades.

Another controversial suggestion involves examining 'socially acceptable measurement and targeted integration of private funds into the public healthcare system' - potentially including patient co-payments or deductibles.

The report calls for improved data collection and use, particularly through better utilization of Austria's electronic health record system (ELGA). Currently, important information from outpatient care is often unavailable or insufficient.

Financing Changes

For hospital care, the Court recommends concentrating services at facilities with adequate staff, technology, and experience rather than having every hospital offer all services. This would particularly affect rural areas, where hospitals could become 'cross-sector care facilities' offering both inpatient and expanded outpatient services.

The Court sees a time window until 2028 for preparatory measures before long-term decisions must be made. It warns that continuing current financing methods risks quality and performance deficits in public healthcare.

Hospital Restructuring

Chancellor Christian Stocker expects results from the planned healthcare reform by year's end, though details remain scarce. Opposition parties have criticized the government's approach, with FPÖ health spokesman Gerhard Kaniak demanding immediate structural reforms.

NEOS social spokesman Johannes Gasser called for profound structural changes rather than piecemeal measures, urging the reform partnership group to deliver sustainable solutions particularly in financing, planning, and governance.