Tyrol Governor Mattle Proposes Single-Hand Healthcare Financing Model

Mattle's proposal would see all tax revenues and social insurance contributions distributed to the federal states according to a specific formula. Each state would then finance both hospitals and outpatient care from a single pool, creating one financing stream per state instead of the current multiple streams.

He described the concept as the much-demanded single-hand financing – "mit neun Fingern," or "with nine fingers," referring to the nine Austrian states. The model would retain existing state boundaries rather than creating a nationwide structure or three to four larger care regions.

Under the plan, separate rules would still be required to manage the cross-state patient treatment issue, known as the 'Gastpatienten-Problematik.' Mattle said a detailed coordination with the other members of the reform partnership had not yet taken place.

Reform Partnership Enters Final Stretch

The proposal comes as the federal government's 18-month timeline to restructure the healthcare system enters its final six months. A stocktaking assessment has now been presented after nearly a year of the reform partnership.

Health Minister Korinna Schumann (SPÖ) had indicated months ago that major overhauls were not to be expected. Chancellor Christian Stocker (ÖVP) recently emphasized that the focus is not on structures but on creating added value for the patient.

Mattle expressed hope that a concrete concept would bring more momentum back to the reform partnership. "Der Termin könnte nicht besser sein," he said, noting the timing of the study's presentation was ideal.

Rising Costs and Fragmented Responsibilities

The push for reform is driven by rapidly rising costs. Since the turn of the millennium, public health expenditure has grown from 7.3 to 9.8 percent of economic output, and now accounts for 17.8 percent of total state spending, up from 14.2 percent.

Inpatient treatment alone accounts for a good 56 percent of all expenditures. WIFO expert Hans Pitlik described the current system as "sehr fragmentiert," creating false incentives.

Pitlik gave an example: if care suffers due to unfilled statutory health insurance doctor positions or limited opening hours, the social insurance is responsible, but the financial impact hits the states whose hospitals patients turn to instead.

Primary Care Expansion and Long-Term Effects

Alongside unified financing, Mattle called for better patient steering and a "massiven Ausbau der Primärversorgung," or massive expansion of primary care. He said he was striving to deliver "machbare und kompromissbereite Überlegungen" and to place patients at the center.

WIFO expert Ulrike Famira-Mühlberger presented the study's findings, noting that no robust evidence was found for the assumption that simply increasing doctor density in a district reduces avoidable hospitalizations. However, measurable relief effects were shown when expansion targets primary care units.

Famira-Mühlberger spoke only of "moderat positiven Effekten," or moderately positive effects, which would only materialize in the longer term. Short-term savings, she said, are not to be expected.