Ombudsman Achitz: States and health insurance funds should first provide services and then decide in the background who will cover which costs
Vienna (OTS) – 19-year-old Marko J. has a rare neurological disease that causes him to lose many abilities in phases. He was in hospital for a long time because of a corona infection, and was due to be released into intensive care at home in autumn 2022. He has to be ventilated and fed via a tube. To prevent him from suffocating, he has to be monitored and cared for around the clock by qualified nurses. “It’s a clear case that the health insurance company is responsible for this; there are supreme court rulings on this. But the ÖGK is once again shirking its obligations,” criticises Ombudsman Bernhard Achitz, who has repeatedly brought the topic up on the ORF program “Citizens’ Advocate”, most recently on June 8. He will also point out to MPs in the National Council that there is a massive need for action.
After several months in hospital, Marko J. was due to be discharged from the hospital in autumn 2022. The Favoriten Clinic prescribed full-day intensive care at home. However, the ÖGK did not seem to want to deal with it any further and returned the prescription without comment.
The Supreme Court has determined that intensive care for people requiring ventilation is medical treatment
Strictly speaking, the ÖGK should provide 24-hour intensive care as a benefit in kind, i.e. send suitable nurses. However, since it has no contractual partner for this, there is a financial subsidy according to the statutes. “The hourly rate does not cover the costs of one hour of care by far,” says Achitz: “Instead of paying out support for at least 24 hours, the ÖGK has now offered ten hours after the Ombudsman intervened. I do not see why the affected families should be haggled over like at a flea market, because the Supreme Court has clearly ruled that intensive care for people requiring ventilation is to be regarded as medical treatment and that the health insurance company must therefore pay.”
Marko J. was able to be discharged from the hospital in February 2023 – but only because the Vienna Social Fund (FSW) promised to temporarily cover all of the costs for which the ÖGK is actually responsible. However, Marko J. and his father were asked to request an actionable decision from the ÖGK and to go to court.
The Ombudsman is calling for the principle of “pay first, then split the costs” to be applied in all cases in which health insurance companies and states disagree about who is responsible. The people affected and their families should not be harassed with endless administrative procedures. Health insurance companies and states should first provide the service and then work out in the background how they will split the costs between themselves,” said Ombudsman Achitz.
Inquiries & Contact:
Florian Kräftner
Media spokesperson in the office of Ombudsman Mag. Bernhard Achitz
+43 664 301 60 96
florian.kraeftner@volksanwaltschaft.gv.at
volksanwaltschaft.at
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