Development of the use of healthcare facilities analysed

- EN - DE

A study by the Medical University of Vienna investigated the development of utilisation of various levels of the Austrian healthcare system between 2006 and 2019. By analysing three population surveys conducted by Statistics Austria, it was found that all’healthcare facilities have a rising number of patient visits. General practitioners were also visited more frequently again. However, the utilisation of hospitals and specialists, which are often overburdened and more cost-intensive, did not decrease as a result. The study results were published in the "European Journal of Public Health".

The research team from the Center for Public Health and the Department of Emergency Medicine at MedUni Vienna investigated the use of healthcare facilities based on the Austrian Health Surveys conducted by Statistics Austria in 2006/07, 2014 and the most recent one from 2019 with a total of more than 46,000 participants. The survey covered, among other things, whether the participants had visited general practitioners, specialists or hospital outpatient clinics at least once in the year before the population survey was conducted or had received inpatient treatment. It was also asked whether the secondary care level (hospitals, special doctors) was utilised without an accompanying visit to a GP (primary care level).

Over the 13-year study period, it was shown that there was an increase in consultations at all levels of care, particularly in the area of secondary care. "Interestingly, GPs have recently been consulted more frequently again," reports study author Roland Kraxner from MedUni Vienna’s Center for Public Health, himself a general practitioner in private practice. The research team also found that the number of patients in secondary care without prior visits to their GP decreased again between 2014 and 2019. However, the increased use of primary care did not lead to lower utilisation of specialists and hospitals.

In a country like Austria, where access to all levels of care can be freely chosen, understanding the usage behaviour of primary and secondary care facilities is crucial. Public healthcare expenditure in Austria is among the highest in the European Union, while the number of healthy life years is below the EU average. The so-called "best point of service" approach is one of the core statements of the current healthcare reform in Austria. This refers to "the right place to provide the best treatment at the right time and at the lowest cost from a social perspective". This concept aims to strengthen primary care, for example by setting up multidisciplinary primary care centres as the first point of contact in the healthcare system in order to reduce consultations at higher levels of care. "However, depending on the federal state, only between zero and 8.72 per cent of the Austrian population has been treated in such a multi-professional centre to date," says Kraxner.

Conclusion of the study: The results of the analysis show a continuing trend towards an increase in the utilisation of healthcare facilities, particularly in the secondary sector. While visits to GPs fell between 2006/07 and 2014, a slight increase was observed between 2014 and 2019, although this did not lead to a reduction in consultations in secondary care. Utilisation of all secondary care services was higher in 2019 for almost all demographic subgroups than ever before during the entire observation period. "These results should be viewed in the context of the ongoing structural healthcare reforms in Austria, particularly in the area of primary care. The effects of these reform efforts are not yet reflected in the data. Once again, the coordinating role of general practitioners for the care of patients at the ’best point of service’ should be emphasised ", stresses Roland Kraxner.

Publication: European Journal of Public Health

Access points to different levels of health care over 13 years. Utilization behaviour in a changing health care system. Results of a three-wave cross-sectional series in Austria.
Roland Kraxner, Thomas Dorner, Dominik Roth, Kathryn Hoffmann.
doi: 10.1093/eurpub/ckae180
https://academic.oup.com/eurpub/­advance-ar­ticle/doi/­10.1093/eu­rpub/ckae1­80/7907600