Primary health care is the first general and directly accessible point of reference for all people with health problems. It aims to coordinate the care of patients and ensures comprehensive and continuous care over time for all health needs, taking societal circumstances into consideration.
Primary health care is offered on a daily basis in the private practices of general practitioners and in hospitals. However, the health care system is in a phase of transition. Health care needs are becoming more complex, life expectancy is rising, and people want to spend this time in good health for as long as possible. Nevertheless, this leads to more chronic illnesses and multimorbidity. Moreover, the Austrian health system is relatively costly since there is a strong focus on hospital utilisation which is more expensive than extramural care. Additionally, there is change of generations within the workforce that has to be addressed adequately. This involves e.g. meeting work-life balance expectations of young professionals and developing a recruitment strategy for general practitioners to compensate additional demand as well as the current and ongoing wave of retirements among physicians. Strengthening primary health care can positively contribute to coping with these challenges by making the profession of a general practitioner more attractive again.
The Austrian health system provides high-quality health services and excellent access to medical care for its residents. All levels of care including general practitioners, specialists and hospitals are available more or less without restrictions, resulting in very high health expenditure. Therefore, in 2013 the federal government, the regional governments and the social insurance institutions agreed on common goals and targets towards a more integrated care in the Federal Target-Based Governance Agreement and the health reform.
With regard to health system structures in Austria, the health reform aims to shift health service provision to the so-called “best-point of service”. The goal is to optimise resource allocation by reducing overutilisation of hospital care and by strengthening primary health care. A special emphasis was on introducing multi-professional and interdisciplinary primary health care units. In 2014, the Federal Target-Based Governance Commission elaborated a concept for primary health care units and this concept ultimately led to the implementation of the Primary Health Care Act in 2017. With the passing of the Primary Health Care Act, the most important requirements and legal framework for the implementation of primary health care units in Austria was established. Further regulatory frameworks include the Collective Agreement and regionally structured finance agreements. In this highly dynamic process, numerous primary health care units have already been established, and many more are in planning or the final stages of implementation.
The regulatory measures including the launch of a comprehensive start-up initiative by the Austrian Federal Ministry of Social Affairs, Health, Care and Consumer Protection have evidently facilitated the acceptance and growing interest in the establishment of primary health care units especially among Austrian physicians. From the patients’ perspective, the primary health care units that have since been established are perceived as a clear improvement for their health care particularly because of the extended opening hours and the multidisciplinary teams.
In the future, the paradigm shift that is already apparent will have an even stronger impact. The shift away from inpatient care to ambulatory care will increase the need for collaboration between various professional groups and sectors. The attractiveness of the profession of a general practitioner and the extramural/ambulatory sector must be enhanced. Primary health care is an essential part of this transformation and can contribute positively to dealing with it.
Especially the drawn-out COVID-19 crisis with public shutdowns and the restricted “basic” services at acute hospitals gave evidence of the high functionality and stronger resilience of primary health care units. They were able to promptly adapt their patient flows to avoid infections and yet maintain the care and treatment within their catchment area. Absences due to infections and /or quarantine could be compensated more easily. Hence, strengthening primary care and the further development of primary health care units will continue to be considered a health policy objective of utmost importance on national and European level.