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
- promote health,
- reduce unnecessary hospital admissions and
- slow down cost growth [Kringos et al 2013].
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].
EXPH (EXpert Panel on effective ways of investing in Health), Definition of a frame of reference in relation to primary care with a special emphasis on financing systems and referral systems 27 February 2014
Fröschl B, Antony K (2017). Evaluation des Projekts PHC – Primärversorgungszentrum Medizin Mariahilf , Kurzbericht zum 1. Evaluierungsjahr, Gesundheit Österreich Forschungs- und Planungs Gmbh, Vienna: 2017. Retrieved from http://www.medizinmariahilf.at/wp-content/uploads/2017/06/kurzbericht_evaluierung_phc_mm_1_zb.pdf
GHZ Enns (2017). Gesundheitszentrumm Enns GmbH [Health care center Enns GmbH]. Retrieved from https://www.ghz-enns.at/
GRUG2017- Gesundheitsreformumsetzungsgesetz2017 – 131 Bundesgesetz, BGBL, 2. August 2017, Wien.
Hoffmann, K., George, A., Dorner, T. E., et al. (2015). Primary health care teams put to the test a cross-sectional study from Austria within the QUALICOPC project. BMC Family Practice, 16(1), 168.
Hofmarcher, M. M. (2010). Ambulatory care reforms fail to face the facts? Health Policy Monitor (2010, April). Retrieved from http://hpm.org/en/Surveys/GOEG_-_Austria/15/Ambulatory_care_reforms_fail_to_face_the_facts_.html, accessed January 2018.
Hofmarcher, M. M. (2013). Austria: Health system review. Health Systems in Transition, 15(7), 1–291.
Hofmarcher, M.M (2017). Ambulant vor Stationär: Wirklich? Eine Sittengeschichte aus Österreich, Vortrag beim 4. Zürcher Forum für Versorgungsforschung, Zürich Juni 2017
Hofmarcher, M.M, S. Mayer, N. Perić, Th. Dorner (2018). Primary Health Care Centers: A Silver Bullet? In Braithwaite et. al. (Ed.), Health Care Systems: Future Predictions for Global Care. CRC Press, in press
HVB, Hauptverband der österreichischen Sozialversicherungsträger. (2015). Umfrageergebnisse: Bevölkerungsstudie – Gesundheit 2015 [Population survey – health 2015]. Retrieved from http://www.hauptverband.at/portal27/hvbportal/content?contentid=10007.758811&viewmode=content
Irving G, Neves AL, Dambha-Miller H, et al International variations in primary care physician consultation time: a systematic review of 67 countries BMJ Open 2017;7:e017902. doi: 10.1136/bmjopen-2017-017902
Kringos, D. S., Boerma, W. van der Zee, J. et al. (2013). Europe’s strong primary care systems are linked to better population health but also higher health spending. Health Affairs, 32(4), 686-694.
Maria Hilf (2017). Medizin Mariahilf, Gruppenpraxis für Allgemeinmedizin OG [Group practice for general medicine OG]. Retrieved from http://www.medizinmariahilf.at/
- the rapid establishment and expansion of primary care outside hospitals and the consolidation of health and care services.
- the regular survey of patient satisfaction taking gender aspects into account.
- the establishment of a “learning centre for primary care“ according to the motto “who needs which skills when?“
- to make progress reports on the development of primary care in Austria.
- to inform public about international evidence through newsletters and infographics.
- to prepare a set of indicators for the evaluation of primary care in Austria.
- low-threshold access to quality of necessary services.
- patient orientation in primary and nursing care, cost-saving.
- primary care centres must become a tradition in Austria.