Disputes hit medical services

Three issues have led Austrian doctors to threaten selective disruptions in service from 17 June 1998. The disputes are partly about pay and partly about working hours and involve doctors on the one hand and employers, the national social insurance system, and chemists on the other.

From 17 June 1998, doctors will mount a series of protests in line with a decision taken on 13 May. These will take the form of public declarations and protest meetings during which services in hospitals will be limited to the level normally available on Sundays. Private practices will also be partly closed, though officially for further training. Three main complaints are at issue, relating to chemists' shops, dentistry and working hours in hospitals.

General practitioners are in upheaval against the Government's plan to deprive them of the right to sell pharmaceuticals to patients. A High Court decision in March 1998 removed the "area protection" for chemists' shops which had meant that only one chemist's outlet could open within a population area of about 10,000 people. In rural districts especially, this meant that there was a stronger network of doctors than of chemists. The doctors' medical cabinets thus provided an important service, though one the Court saw as merely a substitute for proper chemists' services. The Government wants doctors to end sales of prescriptions as soon as a chemist opens nearby. The Chamber of Apothecaries (Apothekerkammer), the compulsory membership body of all chemists, supports this intention. However, the Chamber of Physicians (Ärztekammer), in which membership is compulsory for all general practitioners, has voiced strong resistance, and has won support from the Christian Democrat junior partner in the coalition Government. A compromise is now being discussed but has still not been agreed between the two Chambers. Doctors with a medical cabinet duly applied for and granted before a certain date in 1998, possibly 1 June, will be permitted to maintain the service. New ones granted after that date will have to close as soon as a chemist opens in their area. The issue is exacerbated by 1997's cuts in reimbursements for services from parts of the national health insurance system. These cuts also hit general practitioners in rural areas especially hard.

Similarly strong protests have been emerging from dentists over the Government's plan to permit the national health insurance system's own dentistry services to extend their operations to include crowning teeth. The aim is to bring down the price. As in the case of chemists, the government coalition partners are pitched against each other, not over the aim but over the means of achieving it. A possible compromise may be an official price guideline of, as speculated at one time, ATS 6,500 to ATS 7,000 - about 50% to 70% of prices currently charged. The Association of Social Insurance Providers (Hauptverband der Sozialversicherungsträger, HSV) and the Chamber of Physicians are still negotiating the issue, and the Government set a deadline of 9 June.

The Chamber of Physicians has been demanding the creation of 600 new doctors' posts in hospitals as a remedy against excessive working hours. The Labour Inspectorate (Arbeitsinspektorat) has noted cases of doctors working more than 100 hours per week. It recently inspected 98 hospitals and found 50 in breach of the legal regulations on working hours. Medical staff were found most likely to work excessive hours. The hospitals are owned by the provinces, communities and religious orders, all of which maintain that current levels of service reimbursement by the national health insurance system prohibit recruiting more staff.