SPÖ state leaders oppose health reform and warn of hospital closures

What the reform is about

The background to the rejection is the study "Perspectives on Healthcare 2040" by Gesundheit Österreich GmbH, which contains scenarios for a fundamental structural cleanup. It envisions that in the future there will no longer be hospitals with a limited range of services or fewer than 180 beds. For the state leaders, this would amount to a massive cut to regional healthcare, which is why they reject the reform in its current form.

The study also envisages the expansion of new specialist medical centers. Following the model of the existing primary care units, which according to patient experiences have been well received, around 75 such facilities are to be created by 2040, in which doctors from various specialties and other healthcare providers cooperate. The critics doubt, however, that these centers can replace close-to-home care in rural areas.

Health Minister Korinna Schumann rejected the accusations. "Es ist uns nicht darum gegangen, den Wettbewerb der Kompetenzverschiebungen zu gewinnen, sondern eine gute Versorgung für die Patienten sicherzustellen", the minister said. At a media event, it was also emphasized that planning and control should in future be carried out jointly and in a more "verbindlicher" manner.

Government defends the plans

Health State Secretary Ulrike Königsberger-Ludwig acknowledged at the same time that much more "Hirnschmalz" still needed to be applied to ensure the effectiveness of the reform. This makes it evident that there is still no agreement within the government on the concrete design.

The issue is politically delicate above all for the SPÖ state leaders, who expect a backlash from voters with every structural reform. In Carinthia and Tyrol, there is deep concern that unsettled voters could switch to the FPÖ as they did in 2024 in Styria if regional hospital sites are put up for discussion. This partisan consideration is considered one of the main reasons why a far-reaching structural cleanup seems de facto impossible.

Political costs of the reform

The negotiations on the reform have been ongoing for around a year with the participation of the federal government, states, municipalities, and social insurance providers. So far, the results are modest, reinforcing the impression that larger shifts in competencies between the territorial authorities cannot be pushed through politically. The confrontation between the Health Ministry and the SPÖ state leaders makes an agreement in this legislative period unlikely.

With Vorarlberg, Burgenland, and Carinthia, three SPÖ-led states have already openly opposed the reform plans. The Tyrolean SPÖ under Anton Mattle is also considered skeptical. As a result, the reform lacks a parliamentary majority in the Bundesrat, where the state chamber has a say.

Observers view the conflict as a fundamental structural problem of Austrian health policy. As long as hospital competence lies with the states while the federal government bears the financing, no comprehensive reform will be enforceable against the will of the state premiers.

Outlook on further negotiations

The publication of the study "Perspectives on Healthcare 2040" came at a time when the political fronts had already hardened. Whether the new specialist medical centers will be enough as a compromise offer to bring the states on board is currently unclear.

Further talks between the federal government and the states are expected in the coming weeks. However, it is clear that without the consent of the SPÖ state leaders, no fundamental structural cleanup can be implemented.