Structural and Interface Issues in the Austrian Healthcare System

The issue addressed by the study presented is that public health expenditure, driven by demographic change and medical and technological progress, poses growing budgetary challenges for fiscal policy. Against the backdrop of the current debate on consolidation potential and strategies, as well as the renewed significant overspending of agreed expenditure ceilings for public health expenditure in 2023, the focus is primarily on efficiency gains and potential savings. The Austrian healthcare system is characterised by a high degree of complexity and significant fragmentation of decision-making and funding responsibilities within the federal context: inefficiencies are frequently linked to the federal distribution of responsibilities and the complex funding structures. The initial hypothesis is that, under the current system, there are strong incentives to utilise (expensive) hospital capacities and hospital outpatient departments rather than seeking care from specialist GPs. The aim is to demonstrate whether and to what extent governance problems in the coordination between the various sectors and their link to existing funding structures cause misallocations, inefficiencies and cost dynamics in the Austrian healthcare system. The empirical analysis focuses on the interface between the extra- and intramural sectors to highlight interdependencies in outpatient and inpatient care and to quantify the potential costs arising from insufficient coordination between the care sectors. The study can thus contribute to a rational and evidence-based debate on organisational and financial reforms to improve efficiency and quality in the healthcare system, particularly in a federal context, without yet developing specific and complex reform models.