OECD Network on Fiscal Sustainability of Health Systems , 17th February 2015

Sandra KAISER

Performance Budgeting in Austria

Example: Health

Outline

• Introduction

• Performance Budgeting Framework

• Budget structure & documents

• Conclusions and way forward

2

Characteristics of the Austrian health system

• Cooperation of a large number of actors - Federal Ministry of Health

- Federal Ministry of Labour, Social Affairs and Consumer Protection

- Social Security Institutions

• Competencies are regulated by law - Federal Government plays central role

- Many competencies are delegated to provinces or to social security institutions

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Health expenditures

• Financing health care*: - in total (public + private) ~ 34 bn. EUR = 11,1% GDP

- Public government incl. Social Security Institutions ~ 25 bn. EUR

76% of health expenditures are directly financed by the

public

• Federal Ministry of Health:

Budget sum 2015 ~ 900 Mio. EUR

* OECD definition: System of Health Accounts, 2012

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5

2nd Stage as of 2013: Performance Budgeting

Objectives and benefits

• Establishes comprehensive link between outputs & outcomes with existing budgetary resources

• Facilitates priority setting in policy-making

• Strengthens performance accountability

• Enables transparent presentation of results achieved by the government and its administration for the public and the parliament

Performance Budgeting

Performance budgeting framework

Max. 5 outcome objectives

at least 1 Gender

Global Budget 1 – 5 primary

activities at least 1 Gender

Detail budget

Detail budget

Detail budget

Detail budget

Detail budget

Detail budget

Budget Chapter

P e r f o r m a n c e C o n t r a c t s (internal)

Mission statement

Detail budget

Detail budget

Detail budget

Objectives and

Activities

Global Budget 1 – 5 primary

activities at least 1 Gender

Global Budget 1 – 5 primary

activities at least 1 Gender

Objectives and

Activities

Objectives and

Activities

Objectives and

Activities

Objectives and

Activities

Objectives and

Activities

Objectives and

Activities

Objectives and

Activities

Objectives and

Activities

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Annual Budget Statement

Explanatory budget documents

Budget structure – health example

• Heading/ Rubric - Employment, Social Services, Health and Family

• Budget chapter - Health (UG 24)

• Global budgets - 1. Management and Services

- 2. Financing of the Health Care System

- 3. Prevention and Health of Consumers

• Detail budgets - Ad 1. Center/Ministry of Health

- Ad 1. Shareholdings and Transfers

- Ad 2. Financing of Hospitals

- Ad 2. Additional payments caused by the Family Burden Equalization fund

- Ad 2. Activities for the Social Security Insurance

- Ad 3. Health Promotion, Prevention, and Fight against Drug Abuse

- Ad 3. Veterinary, Foodstuff and Gene Technology Affairs

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Annual budget statement (budget chapter)

MTEF = medium term expenditure framework

Cash Flow Statement Ceiling

MTEF

Budget

2015

Budget

2014

Actual

2013

Receipts 48,713 48,113 85,993

Expenditures – fix ceiling 308,693 308,693 323,644 364,700

Expenditures – variable ceiling 648,351 648,351 629,669 603,902

Total expenditures 957,044 957,044 953,313 968,602

Net cash balance -908,331 -905,200 -882,609

Operating Statement Budget

2015

Budget

2014

Actual

2013

Revenues 49,382 48,702 87,256

Expenses 957,493 953,779 971,008

Net balance -908,111 -905,077 -883,752 Le

ga

lly b

ind

ing

Budget chapter: Health (in Mio. EUR)

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Budget chapter 24 – Health

Mission statement “To enable the population a healthy life” (in brief)

Outcome objective 3 Securing the support, maintenance and regeneration of health

Outcome objective 4 Preventive protection of consumers´ health status

Outcome objective 5 Securing health status of animals and animal care

Annual outcome statement (budget chapter)

Outcome objective 2 Equal access to health care services

Outcome objective 1 Securing a nationwide, easy accessible, jointly

financed and integrated health care system

a

bs

tr

ac

ts

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Outcome objective 2 Equal access to health care services

Annual outcome statement (budget chapter)

Last available value

2012:

925,688

(women:501,194,

men:424,494)

Target value 2014

1,020.570

(women: 529,658, men:

490,912)

Indicator 1

number of women

and men who

attend preventive

health

examination

No Last available value

available, since it was

launched in 2014

Target value 2014

45%

Indicator 2

% of women

between 45 and

70 years who

participate at

breast cancer

screening

Budget chapter at a glance

11

= financial information

= performance information

(outcome statement)

Budget chapter: Health

Global budget 24.01

Management &

Services

Global budget 24.03 Prevention and Health

of consumers

Global budget 24.02 Financing of the

Health Care System

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Outcome objective 2

Equal access to health care services

Annual output statement (global budget)

Link to

outcome

objective

How is this objective achieved?

Measures:

How would success look like? Milestone

and indicators for 2013

Status quo

1 Jointly financing of the HC system: Securing

financial sustainability of the HC system

through consolidation of the financial

capacities, inter alia through binding

contracts of financial targets (expenditure

dampening path) and their implementation

while considering the legally binding budget.

No more debts of the regional

sickness insurance funds by the end of

2013.

The public HC insurance funds have no

deficit in 2013.

According to the 2009

closing of accounts, the

regional sickness insurance

funds had 692 million € of

debts. According to the 2011

numbers, there was no

indebtedness any more, but

net assets of 120 million €.

2 & 3 Quality of results will be analyzed according

to gender as a basis for a monitoring to

achieve a comparable quality of results for

both genders. The basis for this evaluation is

routine data coming from hospitals: Austrian

Inpatient Quality Indicators (A-IQI).

Until the end of 2013, there will be an

instrument for quality of results

monitoring, which will enable a nationwide

standardized measurement in hospitals. They

will mainly analyze statistical peculiarities and

look for reasons for non-compliance with agreed

targets. Afterwards, there will be an external

quality assurance. There will be an analysis in

cardiology differentiated by gender.

Technical implementation is

completed and the available

data material can be used for

monitoring.

!! only a selection !!

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Global budget: Prevention and Health of consumers

= financial information

= performance information (output statement)

= recommendations by the Court of Audit

Global budget at a glance

Explanatory budget documents (detail budget)

Detail budget

24.03.01

Health Promotion,

Prevention, and

Fight against

Drug Abuse

Activity 1 mother-and-child

healthcare

Indicator/Milestone 1 Improvement of

prevention of mother-and

child-healthcare

Objective 2 Ensuring a high quality health of children and

young people, Implementation of a public

vaccination policies, promoting of healthy

nutrition;

Activity 2 suicide prevention with

focus on young people

Indicator/Milestone 2 Carrying out of training

program in various settings

Soft linkage with budget

!!! only a selection of objectives and activities !!!

Detail budget at a glance

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Detail budget: Health Promotion, Prevention, and Fight against Drug Abuse

= financial information

= performance information

Conclusions and way forward

• Discussion in Parliament (Experiences from two past budget-debates)

- Strong focus on outcome objectives, activities and indicators, not on detail budgets

- Debate shifts from unsystematic, input-oriented questions to priorities and strategies of ministries

- All political parties refer to performance information

- Needs to settle down

• Evaluation of the budget reform - done by the Ministry of Finance, involving the line ministries and

the Federal Chancellery (second half of 2014 + 2015)

- One topic: readability and clarity of the budget documents and reports

- Overload of budget information

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Thank you for your attention

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Contact: Sandra Kaiser Advisor on Budget Reform Austrian Federal Ministry of Finance Directorate General II - Budget and Public Finances Tel: +43 1 514 33 502009 s.kaiser@bmf.gv.at www.bmf.gv.at