|Implemented in this survey?|
The main goals and principals of the proposed law are:
The MoH may (financially) support the promotion of quality and he/she may initiate the promotion and incentives to improve and to sustain the quality of health services.
All actors, i.e. providers will be affected.
Sustained development, implementation and evaluation of an area wide comprehensive quality assurance and improvement program in the Austrian health sector based on transperancy, effectiveness and efficiency and in particular oriented towards patients safety.
The MoH may (financially) support the promotion of quality and he/she may initiate the promotion and incentives to sustainably improve the quality of health services.
Non-Compliance with federal quality provisions will be sanctioned and a penality pay may be effected in the order of € 70 000 up to € 100 000. The MoH may publish violations.
All certified health professions and accredited providers, Patients who demand information on structural, process and/or outcome quality
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
The proposal touches to some extent on the professional freedom especially with respect to doctors. However, patient agents claim that doctors have to treat according to guidelines based on medical science anyway; if they do not comply with this, treatment failure may occur. Finally patients have to decide whether they want to be treated or not; thus there is not much space for professional freedom. This approach is been a quite new developement in Austria as generally doctors successfully resisted this in the past. Transparency may increase substantially and the impact on patient choice may be high. In particular, the innovative character of this initiative is due to the stipulation that patients are granted a right with respect to transparency in all quality dimensions.
Quality assurance in the Austrian health sector has been quite fragmented. Standardized quality assurance is been implemented in inpatient care along with the introduction of the
performance oriented payment scheme. However, qualtiy is hardly been monitored in primary care. Within the chamber of physicians primary care doctors began to develop quality work. But
this process lacks transparency and has been a concern for health professionals and politicians in a long time. Quality work is also not very transparent with respect to private and private
non-profit institutions which provide long term care services.
The pre-draft on this legislation is currently being appraised by actors and stakeholders.
Need to comply with the stipulations in the doctors law and other laws on health professionals
|Implemented in this survey?|
The idea was generated by the MoH based on the current government program. The principal purpose is to establish a nation wide comprehensive quality assurance and improvement program.
The quality of health care has been discussed in years. Experts and health professionals have been claiming the need for a quality assurance program. The new aspect is that the federal government has been taken on the lead to promote quality and in particular to address patient safety; patient safety has not yet gotten much offical attention in Austria. In addition, problems with patients saftey seem to be underreported.
The approach of the idea is described as:
Pilot project - BMGF: Aufbau und Erstellung eines österreichweiten Qualitätsberichterstattung
The pre-draft on this legislation is currently being appraised by actors and stakeholders; thus, there is not much information on various positions of affected groups.
Sickness funds are generally supporting the initiative but claim that the law does not address the issue whether compliance with various quality related provisions in other laws on health professionals is achieved.
Generally doctors fear external quality control; in their opinion they need not only develop quality assurance but also monitor it themselves.
|Doctors||very supportive||strongly opposed|
|patients agents||very supportive||strongly opposed|
|Patients, Consumers||very supportive||strongly opposed|
No legislation yet; the implementation is scheduled in January 2005.
|patients agents||very strong||none|
|Patients, Consumers||very strong||none|
All stakeholders will be involved and their committment will be essential to achieve the goals; as the current proposal is a pre-draft of the legislation implementation in 2005 is unlikely.
The policy foresees regular reviews;
The MoH may recommend federal quality guidelines and may enforce quality directives with decrees.
To achieve the goals, the MoH makes allegations on quality reporting which span across states, professions, and levels of service provision. This process is based on the following principals:
The MoH may per decree define the documentation and the reporting.
The MoH publishes the intensity of cooperation and has to make sure that participants are being given feedbacks to the reporting.
The proposal launches the foundation of a "Federal Institute of Quality in Health" designed to support the MoH in realizing its obligations. The main tasks of this institute will be the launch of annual quality reports and the definition of quality standards which either may be enforced by guidelines or by directives.
This policy is highly overdue; the current pre-draft is ambitious but clearly demonstrates the willingness of the government to steward quality of health service provision.
Experts claim that patients rights are finally promoted as patients get a right with regard to the transparency in particular with respect outcome quality.
Some experts claim that the incentives to comply with the provisions may not be appropriate. In order to motivate provider gratifications rather than punishments should be considered; i.e. marks ups and/or flat adjustments to DRGs.
Currently it is hard to judge the outcome as only a pre-draft circulates.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
Cost efficiency may increase but we doubt whether the net effect will outweigh the cost of setting up a comprehensive and nation wide monitoring of the quality of health service provision.
(bill of Health Quality Law in German) Bundesgesetz zur Qualität von Gesundheitsleistungen (Gesundheitsqualitätsgesetz - GQG): 5.8.2004, Vorentwurf
Speech from the MoH in September 2004
BMGF: Messung der Ergebnisqualität im Krankenhaus Endbericht des Pilotprojekts, May 2001 http://bmgf.cms.apa.at/cms/site/attachments/0/4/8/CH0027/CMS1043937954266/ergebnisqualitaet.pdf
BMGF: Das Quality Indicator Project, January 2003, http://bmgf.cms.apa.at/cms/site/attachments/6/3/6/CH0027/CMS1047395847979/qip2003.pdf
Process Stages: Implementation
Maria M. Hofmarcher, Monika Riedel
Proof read by Dr. Gerald Bachinger (patient agent)