Private Hospitals Financing Fund

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AustriaAustria  Private Hospitals Financing
Fund (PRIKRAF)p1
logo
State level Federation , states
legal form Public Law Fund
At sight Ministry of Health
founding 2002
Headquarters Vienna 5 , Geigergasse 5-9 / 4
management Fund Commission
Herbert Schnötzinger (CEO)
Website prikraf.info

The private hospital financing fund (PRIKRAF) serves as a public law fund to finance the services of currently around 45  Austrian bed-managing private hospitals (PRIKRAF-hospitals).

History and legal basis

Basic data
Title: Private Hospitals Financing Fund Act
Long title: Federal law on the establishment of a fund to finance private hospitals
Abbreviation: PRIKRAF-G
Type: Federal law or regulation
Scope: Republic of Austria
Legal matter: Social law
Reference: BGBl. I No. 42/2002 (first version)
Date of regulation: March 9, 2002 ( PRIKRAF regulation, Federal Law Gazette II No. 145/2002 )
New version: Federal Law Gazette I No. 165/2004 ("PRIKRAF Law 2005")
Legal text: ris.bka
Regulation text: ris.bka
Please note the note on the applicable legal version !

The PRIKRAF goes back to the 2001 ASVG amendment, in which the management of private hospitals was made easier to the extent that costs were generally reimbursed. Before that, this was only possible if the recording was necessary “and could not be postponed”. This meant that you could be admitted to private hospitals in an emergency, but the costs of treatment were otherwise only covered for those with private insurance . If there was no such insurance cover, they had to be borne by yourself. Since then, private hospitals have also paid for public health care in Austria's health system . The difference between modern private clinics and, for example, the historically established (also under private law) denominational hospitals is mainly only in the fund from which they are financed.

As a result, the financing was placed on the same basis that previously existed for public hospitals with the hospital funds . In 2002, the federal law on the establishment of a fund to finance private hospitals (PRIKRAF law, Federal Law Gazette I No. 42/2002 ) was passed, with which the fund was set up and drawn up. With the 2005 health reform , the PRIKRAF Act 2005 ( Federal Law Gazette I No. 165/2004 ) was republished .

The relationship between health insurances, federal government, federal states (i.e. public health care) and private hospitals is regulated by the overall contract concluded between the Austrian Chamber of Commerce, the professional association of private hospitals and health resorts, on the one hand, and the main association of Austrian social insurance institutions on the other, as well as individual contracts between a special one Health insurance and a special hospital. The allocation of the fund itself is regulated by the contract concluded between PRIKRAF on the one hand and the main association of Austrian social insurance institutions on the other.

As in other cases, the benefits of private insurance (voluntary supplementary insurance) are charged directly to the patient.

Function and tasks

Financial flows in the Austrian healthcare system
      Bonuses → Private insurance   Special services    
                             
                        Catalog services ( after DRG )      
        Contributions → Health insurance (
compulsory insurance) 		         
                         
        Taxes FA →                        
          → BM (Fin) countries → BGA          
       
                Art. 15a BV-G   ↓ budget   ←      
Country Fund (
LGF) 		   
                →   →          
             ↓    
population   Deductibles   Fund KA ←                  
     
 AN , AG (←) → ←   fee   ←    
        Private KA                
    some deductibles *   ← PRIKRAF ←      
     
              Expense coverage        
or. (←) → Outpatient clinic ←        
                   
    some deductibles *           Flat rate
+  individual services 		       
  (←) → (practicing)
doctor 		←        
          Exp. f. Drugs
+  of pharmacy services 		 
    Prescription fee **                          
patient (←) → pharmacy ←        
                   
    ↑                        
        reimbursement        

(Fin) Ministry of Finance distributes the budget for the Ministry of Health ;
* flows directly to KV carriers;
** flows via pharmacy to health insurance providers;
(←) partly direct reimbursement or exemption for mandatory verse.
Reds: Government Sector,
Yellows: Private Sector

Diagram according to Ziniel (2005)

The PRIKRAF is the compensation office for the services provided by private hospitals for which social health insurance is obliged to provide benefits. The services provided by the private hospitals are checked by the PRIKRAF according to the rules of performance-oriented hospital financing (LKF model) and are subsequently compensated. The PRIKRAF is financed by the health insurance carriers.

Tasks are:

  • Compensation for all services from PRIKRAF hospitals in the inpatient and day clinic area, including services resulting from medical progress, for which the health insurance carriers are obliged to provide benefits. During inpatient care, all intra- or extramural examinations or treatments are covered by the fund offsetting.
  • The payment of nursing care subsidies to insured persons who have been treated in a PRIKRAF hospital.
  • Other tasks that are assigned to the PRIKRAF by laws and regulations.

organization

The office is in the Geiger street in Vienna's Margareten .

Fund Commission

The highest body is the fund commission . In it are represented (with number of representatives):

The tasks of the fund commission include establishing and evaluating the capacity of the fund hospitals to be financed from fund resources; Quality criteria and coordination with the Austrian health planning system; Determination of the preliminary and final point value ; Establishing a catalog of breaches of duty (sanction statute) .

Arbitration Commission

The arbitration commission decides disputes between PRIKRAF and PRIKRAF hospitals. It decides with a notice . Members are a chairman and two assessors.

See also

Web links

Individual evidence

  1. ↑ a b c legal bases, prikraf.info - with links to all relevant legal regulations.
  2. ↑ $ 149 Relationships with hospitals other than those mentioned in § 148 (in particular As. 3) and § 150 care cost subsidy from the insurance company for institutional care, Paragraph 2 of the General Social Insurance Act (ASVG);
    corresponding adaptation of the Federal Hospital Act, Federal Law Gazette No. 1/1957 i. d. F. of BGBl. I No. 5/2001 .
  3. ↑ Parliamentary materials, especially explanations on the PRIKRAF law new, parlament.gv.at.
  4. ↑ a b For billing via PRIKRAF in particular see billing, prikraf.info.
  5. ↑ Reproduced in: Ch. Herber; J. Weidenholzer (Ed.): Assessment approach of the implementation of the health reform 2005 . Linz 2007, p. 133 (PDF, ooegkk.at, accessed on July 20, 2014) - there “Ziniel (2005)” without further details.
  6. ^ The private hospital financing fund (PRIKRAF), bmg.gv.at. > Health system / quality assurance> Institutions
  7. ↑ according to § 150 Abs. 2 ASVG
  8. ↑ a b Fund Commission , prikraf.info.
  9. ↑ Arbitration Commission, prikraf.info.

Coordinates: 48 ° 10 ′ 59.3 ″  N , 16 ° 21 ′ 42.5 ″  E