Health insurance reform – Court of Auditors: more costs instead of billions of patients

The main points of criticism of the Court of Audit (RH) are that the desired harmonization of insurance benefits has only been partially achieved. In addition, since the merger, important supervisory bodies have been missing from the institutions and the umbrella organization. The years 2018 to 2020 and the year 2021 have been checked as far as possible.

With the reform that took effect in 2020, the 21 social security institutions were reduced to five. The stated objectives of the reform: to harmonize services and to reduce the administrative burden. In concrete terms, personnel and material costs in cash register administration must be reduced by 30 percent in order to save one billion euros from 2020 to the end of 2023. According to the plan, this should benefit beneficiaries through comprehensive services.

There is no mention of saving
But these savings are out of the question. Even assuming that costs for administrative work would also have increased without the merger – for example due to inflation – the billion patients announced in September 2018 by the then turquoise-blue federal government by 2023 cannot be represented. On the contrary: in this case too, the auditors calculated extra costs between 34.78 million euros and 134.10 million euros.

The Court of Audit criticized the fact that the Ministry of Social Affairs could not justify how it assumed it would save a billion euros in 2023. The social security institutions did not set themselves any savings targets in the context of the merger during the reporting period. There were also no corresponding provisions in the law. If political goals and professional assessment differ, it is the task of the Ministry of Social Affairs to either develop other measures or to adjust the goals, the RH auditors emphasise.

Unification not achieved
An important aim of the reform was to harmonize benefits within the new social security institutions. But: the differences between the carriers have not become smaller, criticizes the RH. Although the Austrian health insurance fund (ÖGK) has taken steps to harmonize services, a national general contract in the medical field is not foreseeable. While the legislature has reformed the structure of social security institutions, the responsibility of state medical associations as negotiating partners for reimbursement agreements has not changed. The Court sees this as a reason for the lack of standardisation.

Before the reform, a control meeting was provided for each social security institution to monitor the entire financial management. However, since the reform, there is no audit meeting or any other audit body. The court recommends the Ministry of Social Affairs to work towards a legal regulation for the compulsory establishment of a supervisory body. In addition, the recommendation of the Ministry of Social Affairs to set up an audit committee for the general assembly should be implemented immediately.

The AO also sees potential for improvement in the appointment processes at top management level. The ÖGK advertised three management positions without taking into account in the job description whether, for example, a manager was wanted for the IT sector, the financial sector, negotiations with contract partners or for the organization of its own facilities.

Expensive consultancy contracts
In addition, the RH criticizes expensive consultancy contracts without price comparison. For example, the Ministry of Social Affairs commissioned a law firm to carry out an award procedure for consultancy services for three social security institutions for approximately EUR 90,500 without notifying the Ministry’s specialized department of the details. And the Ministry of Social Affairs concluded the framework contract for the consultancy services of the ÖGK without evaluating the concepts and without comparing prices.