The ecology of medical care: access points to the health care system in Austria and other developed countries

Abstract

Objective: This study aimed to analyze the Austrian health care system using the ecology of care model. Our secondary aim was to compare data from Austria with those available from other countries.Design: 3508 interviews employing a 30-item questionnaire related to the utilization of the health care system including demographic factors were conducted. Participants were chosen by a Random Digital Dialing procedure. Further, a literature review of studies of other countries use of the ecology of care model was conducted.Main outcome measures: Austria has one of the highest utilization of health care services in any of the assessed categories. The comparison with the literature review shows that Austria has the highest utilization of specialists working in the outpatient sector as well as the highest hospitalization rates. Taiwan and Korea have comparable utilization patterns. Canada, Sweden, and Norway are countries with lower utilization patterns, and the U.S. and Japan are intermediate.Conclusion: In Austria and similarly organized countries, high utilization of all health care services can be observed, in particular, the utilization of specialists and hospitalizations. The over-utilization of all levels of health care in Austria may be due to the lack of a clear demarcation line between the primary and secondary levels of care, and the presence of universal health coverage, which also allows for unrestricted and undirected access to all levels of care. Previous studies have shown that comparable countries lack the health benefits of a strong primary care system with its coordination function.Key pointsIn Austria and similarly organized countries, there appears to be high utilization of health care in general, as well as with particular utilization of specialists and hospitalizations.The high utilization of all levels of care in Austria may be the result of competition, lack of a clear demarcation line between the primary and secondary level of care, and the presence of universal health coverage.Pathways between primary and secondary care should be strengthened as previous studies have shown that comparable countries lack the health benefits of strong primary care and its function for health care coordination.

Giving patients a voice within healthcare reform: the qualitative VOICE study

“…In addition, participants of this study urgently called for a better coordination und navigation function between the level of care and within primary care. As described above in detail, in Austria, first contact and coordination with primary care are not required (9, 10). In contrast, “[a] strongly developed primary care sector, as defined by the expert panel on effective ways of investing in health (EXPH), commissioned by the European Commission, should ‘play a central role in the overall coordination and continuity of people’s care’ (29) .…”

“…Historically, the public Austrian healthcare system has been structured with two levels of care, which include the hospital and ambulatory sectors. This is disparate from traditional models elsewhere which typically involve three levels of care (primary, secondary and tertiary level) (9). This structure is a barrier to the continuity and coordination role of primary care.…”

“…This structure is a barrier to the continuity and coordination role of primary care. Additionally, Austria has universal health coverage, but no clear demarcation line for access between primary and secondary care (9). Individuals can access with few exceptions secondary specialist care in the ambulatory sector without knowledge or facilitation of a GP, and they do so in much higher numbers than the rest of Europe (9, 10).…”

“…Additionally, Austria has universal health coverage, but no clear demarcation line for access between primary and secondary care (9). Individuals can access with few exceptions secondary specialist care in the ambulatory sector without knowledge or facilitation of a GP, and they do so in much higher numbers than the rest of Europe (9, 10). In addition, mainly solo GP practices exist and number of primary care teams across the country remains low (11).…”

The ecology of medical care in Shanghai

“…During the past decades, the theory of “the ecology of medical care” is popular in academic circles worldwide. Many countries and regions, such as Austria [ 3 ], Japan [ 4 ], USA [ 5 ], Hong Kong [ 6 ], and Beijing [ 7 ], have conducted surveys and applied this theory to describe local ecology of medical care. Furthermore, the analysis framework has been extensively applied to medical services for a certain group of patients, such as pediatric care [ 8 ], asthma patient care [ 9 ], and mental health care [ 10 ].…”