The Rechnungshof is looking for “dringenden Handlungsbedarf” for medical prevention

The number of healthy life years in Austria decreased by 1.6 years between 2014 and 2019. In the report “Health promotion and preventive health care” presented today, the ACA sets out the measures that should be taken to – as intended – increase healthy life years. It further criticizes the fact that the reformed mother-child health passport, which includes, among other things , a hearing screening for newborns, has “Medical Training” And “Medical care in the independent healthcare sector“.

The audited period for this report mainly covered the years 2013 to 2019. Some specific findings also covered the years 2020 and 2021.

Decline in healthy life years

By 2032, everyone in Austria is expected to spend two more years in good health. This was decided by the Council of Ministers in 2012 as one of the ten “Austrian health goals”. But despite this objective, the health situation has deteriorated. According to Statistics Austria, for example, people aged 65 in 2019 could expect to live an average of 9.75 years in good health. In 2014, this value was 11.35 years of healthy life. The ACA critically notes the following: after about a third of the 20-year period set to achieve health goals, healthy life years have not increased, but have actually decreased by 1.6 year between 2014 and 2019. National and international analyzes attribute this, among other things, to the fact that the proportion of the population suffering from chronic non-communicable diseases – such as obesity or mental illness – is high in Austria. There is still a considerable need for targeted prevention measures.

It is urgent to take action

According to a study by the World Health Organization (WHO) on the global burden of disease, the health of populations in Member States of the European Region is most at risk from nutritional factors. In 2001, through several action plans, the WHO called on its European member states to adopt targeted food and nutrition policies. Austria only produced its first national nutrition action plan in 2011; it has not been updated since 2013.

According to the Austrian Health Survey, the proportion of overweight and obese people aged 15 and over increased by four percentage points to 51% between 2014 and 2019. However, this data is based on self-report of respondents who often reported being underweight. The ACA believes that urgent action is needed. Health knowledge should be strengthened among all sections of the population.

Waiver of advertising and binding provisions for the food industry

The Federal Ministry of Health aimed to contribute to improving children’s nutrition. Most of the measures, however, were not mandatory. The ACA recommends that the Federal Ministry of Health work towards implementing an advertising exemption for certain categories of foods before, during and after children’s programs broadcast by audiovisual media services. In addition, the impact of declarations of intent and industry initiatives aimed at reducing the sugar and salt content of foods should be assessed. If necessary, binding provisions should be assessed and initiated.

The reformed mother-child health passport should be implemented quickly

The mother-child health passport is a key instrument for health promotion and preventive health care. The Federal Ministry of Health has recognized the need to move to an updated, evidence-based model. In 2010, it commissioned the Ludwig Boltzmann Institute for Health Technology Assessment to develop a comprehensive set of basic documents for this purpose. It was only in spring 2019 – around ten years after the reform process was launched – that an implementation plan was established. The revised mother-child health passport program would include, for example, hearing screening for newborns and counseling on topics such as passive smoking, nutrition, oral health and accident prevention.
In 2021, based on the Austrian National Recovery and Resilience Plan 2020-2026, the Council of the European Union approved a project presented by Austria to develop an electronic mother-child health passport platform by 2026. According to a statement from the Federal Ministry of Health, the legal basis should be in place by the second quarter of 2023. The programming should be put out to tender by the fourth quarter of 2023. In addition, d By the second quarter of 2026, the proportion of treating doctors and the rate of women using the mother-child health passport must reach 90 percent.

In November 2022, the federal government finally announced that the new digital parent-child health passport would be ready by 2024. Given the announced introduction of a new digital parent-child health passport, the ACA highlights that the changes made to the mother-child health passport already developed in 2019 were not yet implemented at the end of 2022. Financing was also not definitively clarified. It therefore reiterates its recommendation to work towards rapid implementation.

Exercise initiative stalled

In September 2018, the then Federal Minister of Health and the then Minister of Sports presented the initiative “Take the first step” (“Mach den ersten Schritt”). This initiative aimed to bring about a change in behavior among those who exercise little. From the beginning of 2019, the ministries planned to promote 100 basic exercises. However, they failed to implement this measure to the expected extent, as the Federal Minister of Sports resigned in mid-May 2019. At the end of May 2019, the then federal government was dismissed after a vote of no confidence. The interim government did not follow up on this initiative. The website has been deactivated, the videos have been removed from the network.

In May 2019, when the two ministries had already spent 770,000 euros on this initiative, three companies submitted offers for a motive analysis at the request of the Federal Ministry of Sports. The three companies were, on the one hand, the commissioned company, in which a former federal minister worked, and, on the other hand, two service providers recommended to the Federal Ministry of Sports by the same company. Regardless of the possible criminal implications, this procedure was not suitable to guarantee the transparency and competition required. Due to the resignation of the Federal Minister of Sports and the subsequent government restructuring, the award of the contract was delayed. In September 2019, the Federal Ministry of Sports finally concluded the service contract.

2,441 billion euros for health promotion and preventive healthcare

The last time the Federal Ministry of Health studied public spending in the area of ​​health promotion and prevention, to get an overview, was in March 2019, with data from 2016. According to this survey, spending on health promotion and prevention amounted to 2.441 billion euros in 2016. Of this amount, social insurance spent the most, 2.124 billion euros, or 87 percent of all funds. 1.475 billion euros were devoted to so-called tertiary prevention. This includes measures designed to prevent or mitigate relapse, chronification or consequential harm.

In 2016, some 69.84 million euros were spent on health promotion and 296.61 million euros on primary prevention, i.e. the prevention of diseases. In 2014, within the framework of the Federal Commission for Goal-Based Governance (Bundes-Zielsteuerungskommission), the federal government, provinces and social insurance companies decided on a joint health promotion strategy within the Federal Commission management of objectives. However, this strategy was only binding for part of the funds. Furthermore, successful projects were only sustainably guaranteed in 2021.

The ACA recommends that the Federal Ministry of Health ensure sustainable funding for successful projects related to health promotion and preventive health care in collaboration with partners of the Federal Commission on Goals-Based Governance, subject the funds to a common binding strategy and thus strengthen the targeted and coordinated use of funds by all partners (federal government, provinces, social insurance).

Improve data availability

In their report, the auditors highlight many other aspects related to the issue of prevention. In Austria, for example, around 2,400 people die in hospitals every year from microbial infections. This is equivalent to six times more deaths than on the road. Appropriate hygiene measures could prevent 20 to 30 percent of these deaths. The Federal Ministry of Health did not have any data relating to the occurrence of health system-related infections in the independent health care sector. The ACA also notes a lack of data in other areas. These include, for example, vaccination coverage as well as current data on the health status of children and adolescents throughout Austria. It further recommends improving the quality of data on medical examinations and their reporting so that the results derived from them can be used to manage health promotion and preventive health care.