Interview with Alois Stöger, Federal Minister of Health Austria, Austrian Federal Ministry of Health

alois-st-ger-federal-minister.jpgWhat are the historical and strategic factors which position Austria as one of the best healthcare systems in the world today?

The main principles of the Austrian health care system are solidarity, affordability and universality.

Austria’s social insurance system is an important pillar to maintain social cohesion within society. The enactment of the General Social Insurance Act (Allgemeines Sozialversicherungsgesetz, ASVG) in 1956 constituted a major step towards harmonization and simplification of previously existing social insurance legislation. Independent administration of social insurance (certain administrative responsibilities are transferred to those directly concerned: employers and employees) promotes solidarity and cooperation between social partners.

Since its introduction, social health insurance coverage in Austria has constantly been extended and legislation has been adapted to social and socio-political development. Today 99 percent of the population are protected by statutory health insurance.

Good health is considered an invaluable asset in Austria. This is also reflected in health care spending and health system resources. In 2009 about 11% of gross domestic product was spent on health, 78% thereof was generated from public sources. A high density of easily accessible health care facilities exists, patients have considerable choice of provider. Access to high-quality medical care is ensured for all citizens. Equitable health care for all patients is of great importance, services provided by social health insurance do not depend on social status or income.

Austria has always been at the core of Europe’s historical development, and nations often inspire one another. From which healthcare models in Europe has Austria “borrowed” from, and on the other hand which other countries may the Austrian model have influenced?

Austria uses international health system comparisons to aid national and regional health care policy making. Comparisons are undertaken with health systems which are comparable in terms of their health system structure and financing mechanisms, preferably EU-countries. Due to their similar health care systems and the common language German-speaking countries such as Germany and Switzerland are frequently referred to. Countries chosen naturally depend on the topic in question. Innovative approaches of other as the aforementioned countries, such as for instance Scandinavian countries (e.g. for developing the national electronic patient record or quality registries), Belgium or the Netherlands (e.g. when looking at models of psychiatric care for children and adolescents) or the USA (e.g. when designing the diagnosis-related reimbursement system for hospitals in Austria) are also considered as sources of inspiration.

Austrian experts are consulted on a variety of topics e.g. by Eastern European countries. The Ministry of Health and other major organisations in the health system regularly welcome international delegations who are eager to learn about the Austrian health care system in general or about specific topics of interest.

It is interesting to study how Healthcare works in a federal system. To what extent do the Federal Ministry of Health, the Austrian Parliament, the Federal Ministry of Labour, Social Affairs and Consumer Protection, the social security institutions and advocacy groups, and the Länder, work in a collaborative effort to ensure reform continuity?

Austria in fact features a highly fragmented healthcare system in terms of its various regulatory competencies. To put it shortly and simplified, outpatient care delivered by general practitioners and specialists is mainly governed by the social security institutions and the physicians’ chamber in a cooperative manner, whereas the Länder are responsible for the provision of inpatient services in public hospitals. However, the Federal Ministry of Health acts as a supervisor for the social security institutions and the federal parliament is entitled to pass legislation on social insurance law as well as on the principles of outpatient care, which is usually submitted by the Federal Ministry of Health. In order to ensure reform continuity as well as the integration of all stakeholders into the political opinion making process, Austria has established the Federal Health Commission, which is composed of representatives of the Federal Government, the social insurance institutions, the Länder, the physicians’ chamber and other advocacy groups, such as patients’ ombudsmen’s offices and hospital operators. The main tasks of the commission encompass the definition of quality specifications and guidelines, the further development of integrated service provision planning and reimbursement systems as well as the promotion of cooperation in all areas of the Austrian health care system.

All across Europe, as a result of austerity, demographic developments and rising life expectancy, governments are in the search for meaningful savings in healthcare. Recently, the European Health Forum was held in Gastein. What were the main outcomes of the forum, and what are the main strategic and necessary steps the Ministry will take to make the Austrian healthcare system fit for the future, and fit for a new economic and demographic context?

The main outcome of the European Health Forum in Gastein – which we are very proud of hosting in our country – was the consensual insight of all participating experts that savings in health care must not necessarily come along with rationing as long as governments focus on the increase of efficiency and effectiveness. Therefore, the Austrian Federal Ministry of Health, the Länder and the social insurance institution agreed to negotiate a common and co-operative governance system for all relevant levels of health care delivery based on public health goals as well as financial targets for in- and outpatient care on a national as well as regional level. As such, the Austrian Federal ministry of Health aims to raise the effectiveness of the health care system via the further development of the regional health care structure in line with public health needs and to enhance the efficiency of the system by adopting an integrating care perspective and ensuring health care delivery at the best point of service. Finally, we feel indeed privileged, that although the economic crises did also affect Austrian public expenditure, our financial targets still reflect substantial growth rates along with a commitment to link overall increase of public health expenditure to the increase of the gross domestic product.

Health has always been seen by governments as both a social delivery and a driver of the economy. What is your assessment on the attractiveness of the Austrian pharmaceutical market for international investors, and what are you main initiatives and incentives to further attract foreign investment?

Austria is characterized by a stable environment, in general and in the field of health care. The Austrian health care system is internationally well known for its high quality and ranks with regard to several indicators in the upper field. Austria has a tradition in encouraging innovation in medicine; the environment is considered to be supportive for clinical trials. Cooperation between industry and academia is well established, and there are good-practice examples of public-private partnerships. A major asset is the highly-qualified labour force, with global leaders in clinical sciences. Though Austria is not a big country, the Austrian pharmaceutical market is attractive for foreign investment thanks to these benefits. Further, national medicines policies are well advanced, and investors meet transparent regulation, clear procedures and stakeholders’ openness and willingness to engage in dialogue.

What is your action plan and long-term vision for Austria’s healthcare system?

We have already conducted several initiatives led by the Austrian Ministry of Health, which will shape the future development of the Austrian healthcare system: First, the Austrian Board of Ministers has agreed upon national overall health targets, which have been devised by the Federal Health Commission and working groups encompassing all relevant stakeholders. These overall health targets have a broader scope than mere public health goals in a sense. We have tried to identify the major factors determining health in all areas of social life, ranging from education to environmental protection to general working conditions. The second important initiative was the implementation of various e-health applications, first and foremost the implementation of the electronic patient record. This electronic patient record not only contributes substantially to patient safety, it also represents a major driver for increasing efficiency in the Austrian health system in line with the co-operative governance system outlined above. As such, I firmly believe that Austria has taken the appropriate steps to ensure that its healthcare system will also in future meet the needs of both, patients as well as the public as a whole.

Final message from Alois Stöger, Austria’s Federal Minister of Health, to the readers of Pharmaceutical Executive:

To invest in the healthcare system is essential – also in the times of crisis

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