HHE HOPE 2019 - Page 14

HOPE EU hospitals and healthcare services HOPE representatives provide information on the last hospital and/or healthcare reforms implemented in their countries in the last five years and on the elements on the impact of such reforms inefficiency. However, streamlining the historically grown constitutional competences was never feasible. The growing pressure on health systems during, and in the aftermath of the economic crisis, gave impetus for a reform that aimed to overcome the traditional fragmentation and to improve coordination and policy coherence. In 2013, thus, a target-based health governance system for the joint management of the structure, organisation and financing of the Austrian healthcare system was established. The system is based on domestic state treaties, which are concluded for a limited period of time (4–5 years) between the federal and the regional governments with the involvement of the social insurance institutions, while leaving the constitutional division of powers and responsibilities unchanged. In 2017, the second Federal Target-Based Governance Agreement was signed. It sets four strategic goals that are further specified in eleven objectives, concrete indicators and targets and almost 80 measures to be taken at federal and/or regional level over a period of five years. The strategic goals are: • Strengthening ambulatory care while reducing overuse of the inpatient sector and optimising allocation of resources; • Ensuring satisfaction of the population by optimising care and treatment processes; • Strengthening health promotion and prevention; • Ensuring financial sustainability of public health expenditure. In December 2018, a reduction of the number of social insurances funds was decided by the Parliament inter alia by merging the nine AUSTRIA Mr Nikolaus Koller HOPE Governor Mrs Ulrike Schermann-Richter HOPE Liaison Officer, Federal Ministry of Labour, Social Affairs, Health and Consumer Protection Could you describe the last hospital and/ or healthcare reforms implemented in your country in the past 5 years? Due to the federalist structure of the state and the self-governed system of compulsory insurance, the Austrian healthcare system is characterised by a fragmentation of responsibilities for regulating, planning, financing and providing healthcare between the different legislative as well as administrative levels (federal and regional governments) and the social insurance funds. The rather complex blend of different decision- making structures favours frictional losses and AUSTRIA Total current health expenditure as % of Gross Domestic Product (GDP) General government/compulsory current health expenditure as % of total current health expenditure Hospital current health expenditure, as % of total current health expenditure Household out-of-pocket health expenditure as % of total current health expenditure All hospital beds per 100,000 inhabitants Acute care hospital beds per 100,000 inhabitants Acute care admissions/discharges per 100 inhabitants Average length of stay for acute care hospitals (bed-days) Practising physicians per 100,000 inhabitants Practising nurses per 100,000 inhabitants 14 HHE 2019 | hospitalhealthcare.com 2002 9.4% 74.8% n.a. 18.6% 781.0 667.0 25.3 7.3 403.0 712.0 2008 2016 9.7% 10.4% 75.0% 74.1% 38.7% 38.4% 18.2% 18.9% 769.0 742.0 629.0 555.0 26.7 23.5 6.8 6.4 460.0 513.0 753.0 799.0