Primary care

Primary care

Accessible, needs-based, popular

Primary care centres must become a tradition in Austria. To this day, the rapid revovery of patients is the main priority. Coordinated care close to home is still immature. At the same time, more must be done for health and the need for care is growing. We do not have a general shortage of doctors, we have a distribution problem and other health professions are often not adequately deployed. Compared to the rest of the euro zone, relatively little is spent on outpatient care in Austria.

Primary care ensures low-threshold access to person-centred health care. Here, necessary services are coordinated according to need [EXPH 2014]. It is provided by a team of medical and non-medical health professionals. In order to ensure continuity of care, cooperation with patients, relatives and informal carers is very important.

International examples show that such care models

Nevertheless, these models are not very strongly developed in Austria. 85% of general practitioners in Austria work predominantly in individual practices. On average they are open 20.5 hours a week, 50 patients are treated per working day [Hoffmann et al. 2015].

Currently, about one fifth of all physicians who are entitled to practise have contracts with social health insurance. They are selected on the basis of regional staff appointment plans and have a contract with the health insurance institutions [Hofmarcher 2013]. Outpatient care in Austria is mainly provided in such practices. In addition, there is the possibility to visit outpatient clinics or hospital outpatient departments. A doctor in the health insurance system has an average of five minutes fora patient. In Switzerland or Sweden up to four times as much time is available, in Germany it is eight minutes [Irving et al 2017].

Expansion of outpatient care: Always aspired, but hardly established

Since the mid-1970s there have been efforts to expand outpatient care outside hospitals – with moderate success [Hofmarcher 2010]. The 2013 healthcare reform loosened the doctrine that had been in force since then, „outpatient care before inpatient care“, and for the first time the conditions for care at the „best point of service“ [Hofmarcher 2017] were considered. The goal: by 2017, 1% of the population should be cared for in such centres. This goal was not achieved.

Health expenditure per area

in % of total current health expenditure, per capita, at constant prices

Source: OECD November 2017, HS&I Berechnungen.

So far, only two primary care centres (Mariahilf in Vienna and the Enns Health Centre) have been able to establish themselves. They have longer opening hours than individual practices and also offer more services. First evaluations show positive developments in management, trust and job satisfaction [Fröschl et al., 2017].

By 2020, 75 primary care centres are to be established [GRUG, 2017]. This is to be achieved with the help of new facilities or more group practices. Networks of practices or health personnel would also be possible. So far, there is neither transparent documentation nor plans as to how many and which skills are needed in primary care and how adequate remuneration models could be designed. At the same time, the need for care is increasing because the number of people in need for chronical care is growing. In addition, more and more people are living at home who need both: health- and careservices. To achieve this, these both areas need to be better coordinated than in the past. The merger of the social and health ministries in 2017 offer an opportunity that improvements will be achieved in this respect. Surveys show that people in Austria want such primary care centres to be established – thus longer opening hours, more coordination of the offered range of services and more cooperation between the health care professions [HVB 2015].