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Reforming Austria's Highly Regarded but Costly Health System

  • Rauf Gönenç
  • Maria M. Hofmarcher
  • Andreas Wörgötter

The highly regarded Austrian health system delivers good quality and easily accessible services, but is costly. Its governance and funding structure is highly fragmented and it makes too much use of inpatient care in hospitals. Entry and competition opportunities are de facto limited in most health markets. The system operates therefore on a supply-driven basis, and does not have clear mechanisms to optimize spending on a cost-benefit basis. Population lifestyles are also not supportive of good health outcomes and suffer important differences between social groups, raising risks for the future. This Working Paper reviews Austrian authorities’ responses to these challenges, and makes recommendations based on OECD countries’ experiences. The suggested priorities are: i) more clearly assigning the performance, financing and spending responsibilities in the system, ii) enforcing a national capacity plan for publicly-funded inpatient and outpatient care, iii) introducing performance-based payment mechanisms in all services, iv) promoting the transition to “integrated care” by better balancing preventive, outpatient, inpatient, rehabilitation and long-term care, v) emphasizing healthier lifestyles and monitoring progress against national health goals (such as targets for obesity and overweight rates), and vi) better clarifying the medium-term fiscal outlook and scenarios of the system. This working paper is a slightly revised and completed version Réformer le système de santé très apprécié mais coûteux de l'Autriche Le système de santé autrichien, très apprécié, qui dispense des soins de qualité et aisément accessibles, est néanmoins coûteux. Sa structure de gouvernance et de financement est très compartimentée et le recours à l’hospitalisation est excessif. L’entrée dans le secteur et la concurrence sont de facto limitées sur la plupart des marchés de la santé. Le système est donc régi par l’offre et ne dispose pas de mécanismes précis permettant d’optimiser la dépense selon un bon rapport coûts-avantages. Les modes de vie de la population ne favorisent pas non plus de bons résultats en matière de santé et il existe d’amples disparités entre les groupes sociaux, ce qui constitue un risque pour l’avenir. Le présent document de travail passe en revue les mesures prises par les autorités autrichiennes face à ces défis et formule des recommandations fondées sur l’expérience des pays de l'OCDE. Les priorités qu’il est proposé de retenir sont les suivantes : i) définir plus précisément les responsabilités respectives au sein du système en matière de performance, de financement et de dépenses ; ii) mettre en application un plan de capacités pour les soins hospitaliers et ambulatoires financés sur fonds publics, iii) mettre en place dans tous les services des mécanismes de rémunération en fonction de la performance, iv) favoriser la transition vers une « intégration des soins » en veillant à un meilleur équilibre entre soins préventifs, soins ambulatoires, soins hospitaliers, soins de réadaptation et soins de longue durée, v) promouvoir des modes de vie sains et suivre les progrès par rapport aux objectifs nationaux de santé (comme des repères de taux d’obésité et de surpoids), et vi) mieux définir les perspectives et les scénarios budgétaires à moyen terme qui se profilent pour le système. Ce document de travail est une version légèrement révisée et complétée du chapitre spécial de l'Etude économique de l'OCDE de l’Autriche 2011 (www.oecd.org/eco/etudes/autriche).

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Paper provided by OECD Publishing in its series OECD Economics Department Working Papers with number 895.

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Date of creation: 29 Sep 2011
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Handle: RePEc:oec:ecoaaa:895-en
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  1. Unto Häkkinen & Isabelle Joumard, 2007. "Cross-Country Analysis of Efficiency in OECD Health Care Sectors: Options for Research," OECD Economics Department Working Papers 554, OECD Publishing.
  2. Isabelle Joumard & Christophe André & Chantal Nicq & Olivier Chatal, 2008. "Health Status Determinants: Lifestyle, Environment, Health Care Resources and Efficiency," OECD Economics Department Working Papers 627, OECD Publishing.
  3. David Dranove, 2008. "Introduction to Code Red: An Economist Explains How to Revive the Healthcare System without Destroying It
    [Code Red: An Economist Explains How to Revive the Healthcare System without Destroying It]
    ," Introductory Chapters, Princeton University Press.
  4. Isabelle Joumard & Christophe André & Chantal Nicq, 2010. "Health Care Systems: Efficiency and Institutions," OECD Economics Department Working Papers 769, OECD Publishing.
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