Reorientation of the Austrian parent-child preventive care programme. Part III: Financing structures of services and public transfers for parents and young children

摘要

Background and Method: Developing a needs based prevention programme for parents and young children not only requires the identification of effective services but also adequate financing structures. As a basis for reshaping financing structures, we systematically describe current in-kind services and monetary transfers for mothers/parents and children along a timeline from conception, pregnancy and birth until the children’s age of six years. We present financing structures, number and types of services delivered, costs and expenditure as well as explicit and implicit incentives. Our data bases are administrative data, secondary literature and legal documents. Results: The complex spectrum of services is financed by five different payers who are involved in different functions and who represent federal and regional bodies. Reimbursement of in-kind services is based on ‘fee-for-service-payments’ and on ‘lump-sum-payment’. Mother-child-pass examinations, some vaccinations and single services on the regional level are free of charge. For all other services – especially services for children beyond mother-child-pass examinations – co-payments or full private payments are required (e.g. speech therapy). Entitlements to most of the monetary benefits are universal. The remainder (e.g. maternity pay) and most of the in-kind services (e.g. hospital services) are dependent on health care insurance and, hence, on employment. Public expenditure is higher for monetary benefits than for in-kind benefits. Within in-kind benefits hospital services for pregnancy and childbirth account for the highest proportion of public expenditure. Expenditure has risen for almost all of the in-kind and monetary benefits especially for hospital services and reproductive technologies. The incentives that are related to the financing structures support hospital-based, medical and fragmented provision of services. For mother-child-pass examinations, monetary incentives have been introduced that changed from a bonus- to a penalty-system. It is estimated that participation rate is above 80%, however it depends on type of examination; it decreases for child examinations after the age of one and some groups are not reached at all. Conclusion: For the development of a needs-based prevention programme for parents and young children, discussion is needed about whether to reallocate resources from monetary transfers into evidence-based in-kind services and from high-tech reproductive technologies into definite and universally accessible prevention programmes. Service uptake needs to be supported by adequate incentive systems.