Gerald Röhrling

Efficiency, ownership, and financing of hospitals: The case of Austria

While standard economic theory posits that privately owned hospitals are more efficient than their public counterparts, no clear conclusion can yet be drawn for Austria in this regard. As previous Austrian efficiency studies rely on data from the 1990s only and are based on small hospital samples, the generalizability of these results is questionable. To examine the impact of ownership type on efficiency, we apply a Data Envelopment Analysis which extends the existing literature in two respects: first, it evaluates the efficiency of the Austrian acute care sector, using data on 128 public and private non-profit hospitals from the year 2010; second, it additionally focusses on the inpatient sector alone, thus increasing the comparability between hospitals. Overall, the results show that in Austria, private non-profit hospitals outperform public hospitals in terms of technical efficiency. A multiple regression analysis confirms the significant association between efficiency and ownership type. This conclusive result contrasts some international evidence and can most likely be attributed to differences in financial incentives for public and private non-profit hospitals in Austria. Therefore, by drawing on the example of the Austrian acute care hospital sector and existing literature on the German acute care hospital sector, we also discuss the impact of hospital financing systems and their incentives on efficiency. This paper thus also aims at providing a proof of principle, pointing out the importance of the respective market conditions when internationally comparing hospital efficiency by ownership type.

The relationship between outpatient department utilisation and non-hospital ambulatory care in Austria

Background: Coordinated health service utilisation in the ambulatory care sector is of major interest from a health policy perspective. This ecological study investigates the interplay between medical care utilisation in hospital outpatient departments and in freestanding physician practices by drawing on the example of the Austrian healthcare system, which is standing out due to three features: ambulatory care is provided by both free-standing public (contract) and private (non-contract) practitioners; medical specialists operate in free-standing physician practices and in hospital outpatient departments; essentially, no gatekeeping is in place. As the ongoing health care reform aims to strengthen the primary care sector, we investigate whether in the current system care in general practitioner and specialist physician practices is in a substitutive, complementary or independent relation with medical care in outpatient departments. Methods: Hypotheses were tested using ordinary least square regression analysis based on administrative data of all Austrian districts with a hospital department in 2010, including a proxy for actual utilisation rather than physician headcount. Results: Controlling for socio-demographic and geographic characteristics and inpatient activity, we find that a higher level of care provision by contract GPs is associated with lower use of hospital outpatient departments on the district level. In contrast, a higher level of care by non-contract specialists is related to a higher utilization in outpatient departments. Conclusion: While care by non-contract specialists seems to be in a complementary and potentially demand-inducing relation with outpatient departments, primary care by contract GPs appears to be capable of replacing care in outpatient departments.

Gesundheitsausgaben und -versorgung von Kindern im internationalen Vergleich

Die Altersausgabenprofile in der OECD-Studie „Projecting OECD Health and Long-term care expenditures: What are the main drivers?“ erwecken den Eindruck, dass Osterreich im internationalen Vergleich wenig fur die Gesundheitsversorgung von Kindern ausgibt. Wir haben diese Annahme uberpruft: Fur einen Vergleich der Ausgabenhohe mit anderen Landern sind die Altersausgabenprofile (vgl. Abbildung 1) in ihrer Globalbetrachtung allerdings schlecht geeignet: Erstens weisen die einzelnen Lander unterschiedliche Abdeckungsgrade der Profile auf, d.h. zum Teil werden einzelne Ausgabenkomponenten in Landern nicht abgedeckt oder sind nicht nachvollziehbar. Zweitens existieren in den betrachteten Landern unterschiedliche Gesundheitssysteme, Organisationsformen und Berechnungsmethoden, welche die Vergleichbarkeit erschweren. Drittens musste beispielsweise fur Osterreich eine Adjustierung des Profils vorgenommen werden, um eine Konformitat mit der offiziell publizierten Ausgabenquote nach dem System of Health Accounts (SHA) zu erhalten. Vielmehr dienen die Altersausgabenprofile als Ausgangsbasis fur landerspezifische Vorausschatzungen der offentlichen Gesundheitsausgaben. Weiters sei darauf hingewiesen, dass eine isolierte Betrachtung der Gesundheitssausgabenseite ohne Miteinbeziehung des Gesundheitszustandes wenig aussagekraftig erscheint, da in Betracht gezogen werden muss, dass hohe Ausgaben nicht automatisch auch einen guten Gesundheitszustand der Bevolkerung implizieren mussen (siehe bspw. die USA). Mehr Geld fur das Gesundheitswesen ist eine notwendige, aber nicht hinreichende Bedingung fur bessere Gesundheit. Geld kann nur in eine gerechte, effiziente und effektive Gesundheitsversorgung ubergefuhrt werden, wenn geeignete Finanzierungsmethoden verwendet werden und institutionelle Kapazitat und Arbeitskrafte vorhanden sind. Ohne diese Bedingungen konnen zusatzliche finanzielle Mittel fur Gesundheit sogar Schaden anrichten. Durch die Starkung von Gesundheitsforderung und Pravention bei Kindern (Forderung von Bewegung und gesunder Ernahrung – Kampf dem Ubergewicht bei Kindern, Kampf dem Rauchen/Alkohol, Haltungsschaden etc.) Abb. 1: Offentliche Gesundheitsausgaben, in Prozent des Bruttoinlandsproduktes (BIP) pro Kopf, 2000