“If we continue like this, the system will hit the wall”

According to experts, without detailed and wholesale reforms, a “crash” could occur in the Austrian health care system. Expansion of care and restructuring of patient distribution, services and financing must now be tackled quickly and in combination, it said on Wednesday at the presentation of the yearbook of the Praevenire health initiative in Vienna.

Negative example youth psychiatry

An example is child and youth health, and here specifically the care in the field of child and youth psychiatry, said the head of the relevant Vienna University Clinic, Paul Plener: “Compared to before the pandemic, we had to treat three times as many patients after suicide attempts last year.”

The health system, according to the expert, must react comprehensively: expansion of outpatient psychiatric care, more psychotherapy offers for children and adolescents paid for by health insurance and finally: a doubling of the number of inpatient beds in child and adolescent psychiatry in order to achieve a ” European standard”. The OÖN has already reported on the precarious situation in youth psychiatry:

Markus Wieser, President of the Lower Austrian Chamber of Labour, referred to the importance of rehabilitation in the field of child and youth health. There was progress here. But now parents and relatives of children and young people in these facilities must be given the opportunity to accompany them in rehabilitation through paid leave.

State Secretariat required

Wieser called for the establishment of a “State Secretariat for Child and Youth Health in the Ministry of Health” and a “child and youth health billion” in budget funds. Finally, for the relatives of sick children and young people who require a lot of care, the concept of “secondary patients” must also be created as a result of the stress and they must be helped.

“Crossing Sector Boundaries”

According to the experts, a restructuring of patient care from the established to the inpatient area is also essential. Karl Lehner, Managing Director of OÖ Gesundheitsholding: “Hospitals are the top of the healthcare pyramid. We have to do much more to ensure that we cross sector boundaries in healthcare. We have concrete walls between the sectors.” For example, one could save a lot of costs and inefficiencies if hospital outpatient clinics and established medicine were financed, planned and managed from the same pot.

“Flamethrower Makes No Sense”

Drastic formulation of the need for reform Wilhelm Marholdformer head of Vienna’s municipal hospitals: “Not a day goes by without deficiencies in the Austrian hospital system appearing in the media. It makes no sense to go around with the ‘flamethrower’ and attack the medical profession and the health insurance funds. (.. .) If we continue as before, the system will hit the wall.”

For Marhold, there is an urgent need for “outpatient treatment” of a large part of the medical services that can be performed in day clinics. The progress of medicine and technology urgently needs to be reflected in the structures of the hospitals. This also allows for a working environment that meets the current expectations of doctors and nursing staff. “We have to move from thinking about beds to thinking about functions,” demanded the expert.

drug shortages

Described the current difficulties in the supply of medicines Erwin Rebandl, long-time family doctor in Upper Austria and founder of a primary care center: “We have had a lot of streptococcal infections, especially in the past two or three weeks.” Broad-spectrum antibiotics (amoxicillin/clavulanic acid) were only available in pharmacies via magistral preparations. The actually optimally suitable antibiotic, penicillin V, would no longer have existed. In this context, Praevenire board member and Linz hospital pharmacist Gunda Gittler called for mandatory warehousing: “In the intramural area (hospitals; note), we are legally obliged to keep stocks for 14 days. Our upstream suppliers have no legal obligation.”

Different cost development

Alexander Biach, ex-head of the then main association of social security institutions and now deputy director of the Vienna Chamber of Commerce, referred to the different cost trends in the individual sectors of the health care system. Expenditure for public and religious hospitals rose by 41 percent from 2012 to 2021, but expenditure for outpatient clinics increased by 105 percent, and fee costs for resident doctors by 48 percent in comparison. It should therefore make sense to jointly finance and plan outpatient clinics and resident areas in order to prevent patients and services being shifted around because of the different payers (hospitals: primarily federal states; resident area: primarily health insurance companies) in the future.

demands on politics

The yearbook of the Praevenire initiative under ex-head of the main association and ex-finance minister Hans Jörg Schelling (ÖVP) for 2022/2023 contains numerous demands on politicians. These include, among other things: continuous digitization of the healthcare system, more prevention and early detection, reorganization of the professional rights of the healthcare professions, concentration of medical services as part of specialization and expansion of disease management programs for the chronically ill.

“Hospitals will have to change massively. We will not be able to secure (health; note) financing from a single pot,” said Schelling about the ongoing financial equalization negotiations. But at least one funding pool should be created for resident doctors (including primary care units, etc.) and outpatient clinics.

SOS Children’s Villages calls for action

SOS Children’s Villages also warned in a broadcast on Wednesday “of the drastic effects of a blatant lack of care in child and adolescent medicine” and called for swift action. “We are currently dealing with a dramatic situation in which there are far too few checkout counters and the existing ones often remain unoccupied for a long time. The situation is particularly acute when it comes to psychosocial care,” explained SOS Children’s Villages Managing Director Christian Moser. It urgently needs more attention, innovation and budgetary resources from all sides.