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Elfriede Dolinar
President
Austrian Association of Hospital Pharmacists
Director
Pharmacy Department
Vienna General Hospital
University of Vienna
Vienna
Austria
E:[email protected]
Austria, a federal republic of central Europe, is divided into nine states. A member state of the European Union (EU) since 1995, it is now one of the eleven countries of the Euro zone. In 1998 the Austrian population reached 8.08 million, 56% of which lived in urban areas.
The Austrian healthcare system is a social insurance model that is compulsory for all workers, with the Federal Ministry of Health and Women being the supervisory authority of this social insurance system. The Austrian health system is based on statutory health insurance membership. Around 99% of people regularly living in Austria are required to pay contributions to the mandatory health insurance scheme.(1) This scheme is regulated for the entire country by indirect taxes, and for most workers it is enforced in a decentralised manner by nine regional health insurance agencies (one per federal state). For specific professions, health insurance is enforced centrally through five health insurance agencies. In addition, nine major companies offer company health insurance funds.
The statutory insurance scheme ensures early diagnosis of disease, promotion and preservation of general health, precautionary checkups, precautionary human genetic measures, prenatal diagnosis, cytogenetic tests and vaccinations. It also guarantees benefits during illness, intended to partly compensate for loss of income. In this case, the statutory health insurance scheme also provides treatment through medical assistance, remedies, remedial aids, institutional care and medical care at hospitals, further medical rehabilitation, dental treatment assistance and treatment in cases of physical afflictions.(2)
Since 1978, hospital funding has been regulated by way of limited-period agreements between the government and the individual federal states. The funds provided by the state are paid into a structural fund and then transferred on to the nine regional funds according to an agreed allocation ratio. These regional funds are also financed by contributions to the social health insurance scheme, tax resources and other contributions from the federal states and local authorities. Since 1997, regional funds, which enjoy extensive organisational freedom, finance hospitals according to a system of performance-oriented hospital funding (LKF system). The LKF system is a case flat-rate system facilitating hospital funding on the basis of the treatment actually performed on the patients. A total of €17.1 billion was spent on health in 2002 (ie, 7.9% of the €11.7 billion GDP public expenditure on health). Final consumption expenditure on health by general government amounted to €11.1 billion. Of this figure, €5.2 billion were spent on hospital services, €3.4 billion on outpatient services and €2.3 billion on medical products, appliances and equipment. Drug expenditure in Austrian hospitals is on average about 5% of total costs.(3)
Hospital pharmacies
There is a long tradition of hospital pharmacy in Austria, with the first hospital pharmacy built in 1624 as part of the Hospital of the “Barmherzigen Brüder”, which was run by monks. This pharmacy was granted specials rights by the emperor to provide medicines to patients in the same way as a community pharmacy. The hospital pharmacy of the Vienna General Hospital, which is part of the Medical University of Vienna, is the largest hospital pharmacy in Austria, with about 100 staff.
In 2002 there were 312 hospitals in Austria, 51 of which had a hospital pharmacy. Five of them also operate as a community pharmacy. Only major hospitals (“Schwerpunktkrankenhäuser”, or priority hospitals, which provide all medical disciplines) are required by law to have a hospital pharmacy. Private hospitals are not permitted to run a hospital pharmacy.(4)
Educational requirements and licence
Working as a hospital pharmacist does not currently require any special education in addition to the Master’s in Pharmacy degree, although one year of internship under the guidance of an experienced pharmacist is required. Due to harmonisation within the EU, a course in pharmaceutical care has become part of the curriculum. An educational programme for specialisation as a hospital pharmacist has been developed and is to be implemented by the Austrian Chamber of Pharmacy by October 2004. This educational programme covers three years of on-the-job training, in addition to 240 hours of several courses on different topics.
To become director of a pharmacy department, a 5-year experience in hospital or community pharmacy is required. Some hospitals ask for an additional education in economics and hospital management. Due to the implementation of quality management in hospital pharmacies, a course in this field is provided by the hospital management.
Organisation and staff
In 2002, a total of 225 pharmacists and 476 supporting staff (pharmaceutical technicians and pharmaceutical commercial assistants) and facility staff were employed by Austrian hospital pharmacies. By law, the head of the hospital pharmacy can make independent decisions. There are no regulations on who the head is reporting to: this person may be the medical director or the financial director.(4)
Responsibilities
Hospital pharmacies in Austria care for in- and outpatients treated at the hospital’s outpatient departments and for patients in nursing homes. The supply of medicines, diagnostic products and medical devices, the preparation of specific medicines and the pharmaceutical support of medical therapy and nursing are the main services offered by hospital pharmacies.
Purchase
Hospital pharmacists, who are responsible for the purchase of pharmaceuticals, negotiate with pharmaceutical companies and wholesalers. To achieve competitive purchase prices, there is cooperation between hospitals.
Production and compounding
Drugs are compounded on small (eg, prescription) and large scales. Unavailability of commercial products, short-term stability of compounded drugs, safety considerations, adaptation to specific patient demands and cost savings are the major reasons for drug production in hospital pharmacies. Drug production includes cytotoxic preparation, total parenteral nutrition, filling of analgesic pumps, other parenteral drugs, ophthalmics and paediatric dosage forms (eg, powder in gelatine capsules, ointments and suppositories).
Pharmaceutical services
Hospital pharmacists work closely with physicians and nurses and are in direct contact with the patients to assure the safety, efficacy and efficiency of drug use. In some hospitals, clinical pharmacy is implemented; some clinical pharmacy projects include participation in ward rounds and pharmaceutical discharge. In many hospitals, interdisciplinary teams are established (teams for nutrition, hygiene, wound management or pain management), in which hospital pharmacists are team members.
All products used in a hospital that should be authorised by the hospital’s drug committee are listed on a special house list. Hospital pharmacists are involved in the decision as to which drug is listed, and they participate in the development of guidelines for safe and effective therapy and care.
Since 2003, drug committees and drug lists are mandatory by law. In most hospitals, the head of the pharmacy is the manager of the drug committee. In addition, computer-based drug information services are offered by several hospital pharmacies.(5)
Conclusion and outlook
The healthcare system in Austria has recently undergone major changes, as the expenditures for drugs are rising. Therefore, the system of reimbursement of drugs by the social health insurance needs to be updated. Pharmaceutical companies, wholesalers and community pharmacies get less money. The principal aim is to reduce costs by prescribing more generic drugs. A change in the funding of health insurances and hospitals is also being discussed.
Resources
- Medicines and Health Care Management in Austria. Brussels: HOPE; 2001.
- Health Care in Europe. MISSOC-Info 03/2003.
- Health expenditure in Austria. Statistic Austria 11.2003.
- Die Apotheke in Zahlen. Österreichische Apothekerkammer 2003.
- Hospital Pharmacy in Austria. Austrian Association of Hospital Pharmacists; 2000.
