Health technology assessment in Austria

The Austrian healthcare system relies mainly on physicians in private pract ice and on Various services provided by hospitals. The social health insura nce scheme is compulsory, covering 99% of the population. The system is ver y decentralized. While the federal stale provides the framework, the nine a utonomous provinces are responsible for administering health and social ser vices. There is ongoing public discussion about centralizing the healthcare system to make it more efficient and to enforce structural reforms. Becaus e of concerns about healthcare expenditures, in 1997 the Performance-Relate d Hospital Financing System (LKF), a system similar to the diagnosis-relate d group system, was introduced for hospitals, including a plan for large me dical devices. It is too early to evaluate the success of this new system, although some effects of the LKF system that could have been anticipated, s uch as shortened lengths of stay and more hospitalizations, have been seen. Previously, health technologies have been almost uncontrolled in Austria. The evaluation of health technologies as an instrument to support or to con trol their dissemination and use or to help define policies is not institut ionalized or systematically used. It seems clear that structural reforms of the Austrian healthcare system are needed. Health technology assessment sh ould be part of such reforms.