Agreement In Accordance With Article 15A B-Vg Target Control-Health

Original Language Title: Vereinbarung gemäß Art. 15a B-VG Zielsteuerung-Gesundheit

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Agreement under Art. 15a B-VG Target Control-Health

The Federal Government, represented by the Federal Government,

the country of Burgenland, represented by the governor of the country,

the Land of Carinthia, represented by the provincial governor,

the Land of Lower Austria, represented by the regional governor,

the Land of Upper Austria, represented by the governor of the country,

the Land of Salzburg, represented by the country's main wife,

the Province of Styria, represented by the Governor of the State,

the Land Tirol, represented by the provincial governor,

the State of Vorarlberg, represented by the provincial governor and

the Land of Vienna, represented by the provincial governor,

in the following Contracting Parties, agree to conclude the following agreement in accordance with Art. 15a B-VG:

table of contents

Preamble

1. Section General provisions

Article 1

Subject matter

Article 2

Scope

Article 3

Definitions

Section 2 Health policy principles

Article 4

Orientation towards the framework-Health objectives and public health

Article 5

Principles, objectives and fields of action of the target control-health

Article 6

Patient orientation and transparency

Article 7

Quality assurance in Austrian healthcare

3. Section Structure and sequence of target control-Health

Article 8

Multi-stage of the target control process

Article 9

Ratio of target control-health to ÖSG/RSG

4. Section Decision structures and organisation

Subsection (A) Decision structures and organisation at the federal level

Article 10

Organisation of the Federal Health Agency

Article 11

Federal Health Commission

Article 12

Federal-Target Control Commission

Subsection (B) Decision structures and organisation at the country level

Article 13

Organisation of the State Health Fund

Article 14

State-of-the-art health platform

Article 15

Country-Target Control Commission

Section 5. Concretization of the partnership objective-Health

Article 16

Orientation of the target control-health

Article 17

Result orientation control area

Article 18

Control Area Supply Structures

Article 19

Control Area Supply Processes

Article 20

Preferences and content of the country-Target tax treaties

Article 21

Annual work programmes

6. Definition of financial target control

Article 22

Financial Objective Control-General provisions

Article 23

Strengthening health promotion

Article 24

Content and subject of the financial framework contracts

Article 25

Determination of the spending fight path for the first period at the federal level

Article 26

Determination of the expenditure fight path for the first period in the countries

Article 27

Determination of the expenditure attenuation path for the first period in the field of social security

Article 28

Virtual Budget

7. Section provisions on monitoring and reporting

Article 29

Implementation of a monitoring and reporting system

Article 30

Process steps

Article 31

Financing of monitoring and reporting

Article 32

Detailed rules for monitoring and reporting

8. Section Rules on the Sanctions Mechanism

Article 33

General

Article 34

Arrangements for non-achievement of defined objectives

Article 35

Regulations for violations of this agreement, the federal target tax treaty, or the country-target tax treaties

Article 36

Regulations for non-implementation of the federal government tax treaty or the country-to-target tax treaties

Article 37

Dispute settlement procedure for disputes arising from the federal target tax treaty or the country-Target tax treaties within the framework of the target control-Health

9. Section Key points for statutory regulations for the establishment of target control-Health both at federal and state level

Article 38

Legal regulations at federal level

Article 39

Legal regulations at the state level

10. Section Other provisions

Article 40

Special provisions for the event of natural disasters or exceptional emergency situations

Article 41

Federal support obligation

11. Period of validity and final provisions

Article 42

entry into force

Article 43

Implementation of the agreement

Article 44

Duration, external force

Article 45

Communications

Article 46

Original

Preamble

In the interest of the people living in Austria, the Federal Government and the Länder, on the one hand, and the social security system on the other, agree on the other hand as equal partners, a partnership-based target control system for the management of To establish the structure, organisation and financing of Austrian healthcare. Against the background of the existing competences, this agreement, in accordance with Art. 15a B-VG, pursues the objective of achieving optimal impact orientation as well as strategic and economic development by means of modern forms of a contractually supported state organisation. results-oriented cooperation and coordination in the performance of the respective tasks. It is a "governance" of responsibilities for health care that corresponds to the interdependencies, in order to achieve the equivalent of the principles of impact orientation, accountability, accountability, openness and transparency of structures. or processes and fairness and in order to ensure both the best possible health services and their financing.

Through the contractual principle of cooperation and coordination, the organizational and financial interests of the system partners are to be overcome.

In this context, the target control system health builds on the following principles of policy:

1.

For patients, low-threshold access to demand-oriented health care and its high quality are to be secured and expanded in the long term.

2.

The responsibility for the use of the taxes and contributions provided by the population calls for tools to increase the effectiveness and efficiency of healthcare.

3.

In the sense of the principle of impact orientation in health care, it is about the further development of organization and control mechanisms at the federal and state level.

4.

In addition, both the definition of supply and financial targets for the part of health care covered by this target control health are also concerned as well as a monitoring to measure the achievement of the target.

5.

In the future, all measures taken by the Federal Government, the Länder and the Social Insurance Fund within the framework of the target control health should be subject to the optimal health care of this common orientation.

6.

The increase in public health spending (excluding long-term care) is due to the expected average nominal growth of gross domestic product over the period to 2016, which means that in the perspective up to 2020, the The share of public health expenditure in gross domestic product is stable at around 7 percent.

Section 1

General provisions

Article 1

Subject matter

(1) The Contracting Parties agree, beginning with 1. January 2013 an integrative partnership objective-Health for the structure and organisation of Austrian healthcare, with the inclusion of social security as an equal partner, and together development.

(2) The concretization of this target control-health is carried out on the basis of comparable, effect-oriented qualitative and quantitative determinations.

1.

Supply Targets

2.

Planning Values

3.

Supply processes and structures

4.

Result and quality parameters.

Building on this is an integral part of a

5.

Financial Target Control

to establish.

Article 2

Scope

(1) The scope of the planned target control-health comprises in structural and organisational terms all intra-and extramural areas of the Austrian health system as well as any affected seams (e.g. (b) for the care and rehabilitation area).

(2) The basis of the system is the currently existing responsibilities and tasks of the partners in the health target control system.

Article 3

Definitions

1.

"Ambulatory area" : outpatient health care in hospital bullets, self-employed outpatients and in the established area (in particular medical assistance and equivalent services within the meaning of SV-law).

2.

"Best point of service" : The curative care is to be provided at the right time in the right place with optimal medical and nursing quality as cost-effective as possible.

3.

"Health in all policies (health in all policy areas)" : By increasing the health and determinants of health issues in areas other than those directly responsible for this purpose, the health of the population should be promoted effectively and sustainably.

4.

"Health Technology Assessment (HTA)" : Process for the systematic evaluation of medical technologies, procedures and tools, as well as organisational structures in which medical services are provided. Criteria such as effectiveness, safety and costs are examined, taking into account social, legal and ethical aspects.

5.

"Integrated supply" : Integrated care is the patient-oriented joint and coordinated cross-sectoral healthcare, including adjacent areas (acute care, outpatient care, rehabilitation, interface to the nursing care sector). It includes process and organizational integration.

6.

"Interdisciplinary Supply Models" : Cooperation of physicians of different departments (general medicine, internal medicine, gynecology, laboratory, radiology etc.) as well as of non-medical health service providers (qualified nursing staff, Physiotherapists, physiotherapists, etc.) in group practices or self-employed outpatient clinics as well as in further organizational forms to be developed.

7.

Primary Health Care (Primary Health Care) : The general and directly accessible first contact point for all people with health problems in the sense of a comprehensive basic supply. It is intended to coordinate the supply process and ensures holistic and continuous support. It also takes into account social conditions.

8.

"Public Health" : creation of social conditions, environmental conditions and conditions of needs-based and effective and efficient health care among which populations can live healthily.

Section 2

Health policy principles

Article 4

Orientation towards the framework-Health objectives and public health

(1) In the sense of the "Health in all Policies" approach, the further development of goals, structure and organisation of health care in the context of target control-health is in line with the decision to be decided by the Federal Health Commission. Framework health objectives. The framework health goals are defined in federal and state health objectives, ensuring that any country health objectives that have already been defined are in line with the framework health goals.

2. The Contracting Parties agree to orient themselves in the implementation of their measures to Public Health principles. These are, among other things:

1.

Orientation towards a comprehensive health concept

2.

Systematic health reporting

3.

Further development of the Public Health Service (ÖGD) taking into account Public Health

4.

Supply research to ensure demand-oriented planning, development and evaluation

5.

Strengthening the interdisciplinarity in supply and research and development with the aim of improving health for all and reducing health inequalities

Article 5

Principles, objectives and fields of action of the target control-health

(1) The following principles are to be followed:

1.

The promotion of health promotion and prevention

2.

in the case of illness, the curative care at the "best point of service"

3.

the binding commitment to active cooperation and mutual support between the Federal Government, the Länder and the social security system in the implementation of the jointly agreed objectives

4.

Patient-oriented quality in health care has to increase the effectiveness and efficiency of healthcare

5.

the data necessary for the purpose of the target control, including the integrated planning, shall be made available for all sectors in a suitably prepared and comprehensible form

(2) In order to achieve these principles, the following objectives will be implemented, in particular within the framework of the target management health system:

1.

Targeted health promotion and prevention, reinforcement of evidence-based early detection and early intervention

2.

Improve access to and availability of all necessary services

3.

Coordinate the range of services in all sectors, design patient-and needs-oriented, and prevent parallel structures. Deconstruction

4.

ensure high quality of treatment and make it more transparent

5.

Improve treatment processes, in particular by eliminating organizational and communication deficits

6.

Routine measurement of supply effectiveness intensifying

7.

Align financing and reward systems more closely with the supply needs

8.

on all levels of care, giving priority to the establishment of multiprofessional and inclusive forms of supply compared to single-power providers

(3) In order to pursue these common goals, the following fields of action must be worked on within the framework of the target control-health:

1.

The "best points of service" are to be defined by means of supply orders and the right start-up and further treatment points are to be made transparent. The financing needs to be adapted to performance shifts across sectors (Art. 24 para. 2 Z 6 or Art. 24 (3) (7)).

2.

The inpatient area in the acute care hospitals is medically and economically justified shifting of services into the daily clinical and/or clinical trials. to relieve outpatient care. The provision of services must be developed in line with needs in particular in the outpatient sector and should be coordinated with each other with regard to the range of services (hospital bullets, independent ambulatories and established areas), and . Furthermore, on the basis of objective cost and benefit assessments, taking account of existing outsourcing, it is necessary to undertake relocations in the direction of more efficient structural alternatives and to reduce inefficient structures. Parallel structures-v. a. Outpatient medical care in the established and hospital-like area-are to be reduced.

3.

The area of primary health care ("Primary Health Care") is also to be strengthened according to the international model in the established area.

4.

For selected disease patterns, care standards are to be defined on patient needs.

5.

In order to improve the supply processes, especially in the case of chronic diseases, disease management programs are to be developed and implemented, interdisciplinary and multi-professional coworking methods are to be developed and treatment processes are to be developed. define.

6.

A comprehensive, comparable, systematic and standardised quality management system (with comprehensive measurement of the quality of the results) is to be established both in the intramural and extramural areas.

7.

Financing and payment systems shall be designed in such a way as to support the objectives of the target management-health (in particular, the "best point of service").

Article 6

Patient orientation and transparency

(1) In the sense of patient orientation, the health competence of the population is to be strengthened in such a way that the active participation of the persons concerned in decision-making processes is possible. The partners of the target control-health have to ensure the use of digital information systems in the field of eHealth. Such information shall include, in particular, transparent information on offers, services and results of healthcare service providers.

(2) Surveys on the subjective state of health of the population and cross-sectoral patient surveys must be carried out on a regular basis.

Article 7

Quality assurance in Austrian healthcare

(1) The work on the construction, development, safeguarding and evaluation of a comprehensive Austrian quality system has a uniform nationwide, national, sectoral and cross-disciplinary, in particular including the the established area. Part of the quality system is also measures for patient safety, quality development and quality promotion. In any case, all the provisions relating to the quality system must comply with the requirements of the target control health and, in particular, the monitoring provided therein. Quality work has also made a significant contribution to increasing the effectiveness and efficiency of health care in the medium to long term and thus improving the health care of the population and its long-term health care. Financial viability.

(2) The Austrian quality work has the levels of structure, process and result quality based on the Health Quality Act, BGBl. I No 179/2004, as amended by the Federal Government, to include the Federal Government. The quality of the structure, process and results must be in a direct and balanced relationship with each other, with the development or Further development of result quality indicators and their measurement in all sectors of the health care system is a priority.

(3) In the field of the quality of results, the following shall be established:

1.

For the stationary area, the already existing result quality measurement and assurance based on routine documentation (A-IQI incl. Peer review procedure, supplemented by quality registers at the federal level) to continue and expand.

2.

Taking into account international models and experiences, an adequate, comparable system for health service providers in the outpatient sector shall also be available within 18 months of the entry into force of this Agreement. To develop and implement results-quality measurement and protection. To this end, the Federal Government has to give substantive guidelines on the basis of the Health Quality Act. Social insurance, the Austrian Medical Association and the Austrian Chamber of Commerce (as a representative of healthcare companies within the meaning of section 149 (3) of the ASVG) are to be included in the development process.

3.

The quality assurance of the medical profession as well as the perception of the quality measurement and assurance of results in the established area take place in the transferred sphere of activity in accordance with the requirements of the Federal Government.

(4) In the field of process quality, for those areas where this is considered necessary and urgent it is in close contact with the fields of action of the target control-health (Art. 5 (3) (3) (4) and (5)) to establish uniform quality standards throughout Austria.

(5) In the field of structural quality, the criteria are laid down in the Austrian Structural Plan for Health (ÖSG). For the intramural area, a revision and redimensioning of the structural quality criteria contained in the ÖSG 2012 is based on the necessary specifications in accordance with the provisions of Article 4 (4) (4) of the agreement in accordance with Art. 15a B-VG on the Organization and financing of health care, BGBl. I No 105/2008, as amended. Within the scope of future ÖSG revisions, structural quality criteria for the outpatient sector are to be supplemented with the necessary requirements.

(6) ensuring quality, including participation in nationwide quality assurance measures, is-irrespective of the institution or institution in question. Establishment of health care services-compulsory. It is legally necessary to ensure that compliance with the established essential quality standards is a prerequisite for the provision and accountability of the services.

(7) A master plan shall be drawn up for the further development of quality in the healthcare sector. The work on a regular national and cross-sectoral reporting on quality in the health care sector should be pursued in a thematic context. As of 2014, reports on the quality of results in the inpatient and outpatient areas will also be regularly reported in the context of this reporting. In addition, a report on the training of physicians should be drawn up. Publication of these reports in a suitable form shall be ensured.

(8) The Federal Government, the Länder and the Social Security Fund may take advantage of the health of Austria GmbH (GÖG) for the scientific support of the work referred to in paragraph 1 above.

Section 3

Setting up and running the target control-health

Article 8

Multi-stage of the target control process

(1) The target tax process shall be carried out at the federal and state level in accordance with recognised procedures.

(2) The strategic objectives and the measures to be implemented for achieving the objectives are agreed in four-year contracts at the federal level (accrual-related federal tax contracts) and country level (accrual country-related country-to-target tax contracts) and is binding. The concrete implementation is carried out in annual work programmes.

(3) In the sense of strategic cooperation and coordination, the following process steps are to be carried out at the federal level:

1.

The detailed design of the target control-health at the federal level and any measures to be implemented at the federal level are to be defined between the federal government, the Länder and the social security system by means of federal-to-target tax contracts, whereby to take account of macroeconomic impacts and regional needs. These contracts shall include the contents laid down in Sections 5 and 6.

2.

In the Federal-Target Control Commission, the draft for the Federal-Target Tax Treaty is to be advised and for decision-making to be recommended by common accord of the Federal Government, the main association of Austrian social insurance institutions and the Länder. After approval by the respective competent organs of the Federal Government, the Länder and the Social Security (Hauptverband after decision-making by the carrier conference), the contract shall be made legally binding and shall be acquired in a legally binding way. so that legal validity. Within 14 days of the Federal-Target-Control Commission and the Land-Target Control Commissions, the underwritten Federal-Target Tax Treaty is to be brought to the attention of the Federal Government.

3.

The draft of the first federal target tax treaty for the years 2013 to 2016 has to be submitted by 30 June 2013. Federal target tax contracts for the further periods are to be set up to the middle of the year preceding the period preceding the period. Any adaptations of existing federal target tax contracts shall also be due by the middle of the year at the latest, which precedes the year in which these adaptations become relevant for the target control.

4.

The federal target tax treaties are to be specified in relation to the individual years, if necessary to adapt and to operationalize in annual work programmes at the federal level. The annual work programme for measures at the federal level for the year 2013 is to be agreed at the same time as the first federal target tax treaty. The annual work programmes for the following years shall be agreed by the German Federal Government's Target Control Commission by the end of the previous year at the latest.

5.

A federal, effective and efficient monitoring and reporting system at the federal level is to be established.

(4) In the sense of strategic cooperation and coordination, countries and social security are jointly responsible for the achievement and implementation of the objectives and cooperations defined in the target control health. In particular, the following process steps must be carried out:

1.

The detailed design of the target control-health at the country level is to be agreed and implemented on the basis of the contractual stipulations at the federal level by country-objective tax contracts between the country and the social security system. These contracts shall include the contents laid down in Sections 5 and 6. The financial framework agreement agreed between the country and the social security system shall be binding, and the sanctions mechanism shall apply in the event of non-compliance in accordance with Section 8.

2.

In the country's target steering committee, the draft for a country-to-target tax treaty is to be advised and to be recommended by common accord for decision-making in the relevant bodies of social health insurance and the country. If this draft is the federal target tax treaty or The Federal Government has a right of veto. The contract is subject to approval by the respective competent authorities of the respective country and by the social health insurance (locally responsible regional sickness insurance fund, insurance institution for the public service, social security institution of the industrial economy, the social security institution of the farmers and the insurance institution for railways and mining), legally binding, and thus obtained legal validity. If a contract is not signed by all health insurance institutions in the country, this contract between the signatory parties shall nevertheless be concluded, provided that the Federal Target Control Commission does not achieve the expected achievement of the objectives. at risk, which is why no veto is being introduced. Within 14 days, the country's target tax contract is to be brought to the attention of the Federal Government's target steering committee and the respective country's target steering committee.

3.

The draft of the first country-target tax treaty for the years 2013 to 2016 has to be held until 30 September 2013. Country-to-country tax contracts for the other periods shall be subject to the end of November of the year preceding the period preceding this period. Any adaptations of existing country-to-target tax contracts must also be made by the end of November of the year preceding the year in which these adaptations become relevant for the purpose of the target control.

4.

The country's target tax treaties at the respective country level are to be specified in relation to the individual years, if necessary to adapt, to operationalize in annual work programmes and to implement them in the respective spheres of action. The annual work programme for the measures at the national level for the year 2013 is to be agreed at the same time as the first country-to-target tax treaty. The annual work programmes for the following years shall be agreed by the respective country's target tax commission by the end of the previous year at the latest.

(5) It is agreed that a subsidiary of health Österreich GmbH shall be established, through which the work on the implementation of the tasks within the framework of the target tax health, in particular monitoring (reporting) and quality work The following: The Federal Government, represented by Health Austria GmbH, the Länder and the Social Health Insurance, represented by the Main Association of Austrian Social Security Institutions, are part of this subsidiary (each one). Third). In the sense of a resource-conserving management, it is to be determined that the managing director of health Österreich GmbH will lead the business of the subsidiary.

Article 9

Ratio of target control-health to ÖSG/RSG

(1) The Federal-State Tax Treaty and its implementation in the respective annual work programmes shall be based on the provisions of the Austrian Structural Plan Health (ÖSG) which have already been agreed. The further orientation of the Austrian structural plan health is determined by the higher-level target control-health.

(2) The country-to-target tax treaty and its implementation in the respective annual work programmes builds on the already agreed provisions of the respective regional structural plan health (RSG) at the country level and is superior to the latter. The structural measures agreed jointly within the framework of the target control health at the state level have, in accordance with the guidelines agreed in the German Federal Government and the ÖSG, in accordance with the terms of reference in the respective regional states. Structural plan health to be incorporated.

(3) On the basis of the central definitions and requirements of the target control-health, the Austrian structural plan health and the regional structural plans health are central planning instruments in structural and content-related fields. to develop respect for, and in compliance with, the criteria of supply, quality and efficiency.

4.Section

Decision structures and organization

Subsection A)

Decision structures and organization at the federal level

Article 10

Organisation of the Federal Health Agency (pursuant to Art. 14 of the Agreement pursuant to Art. 15a B-VG on the organisation and financing of the health care system in the current version)

(1) The following institutions shall be set up in the Federal Health Agency:

1.

Federal Health Commission

2.

Federal-Target Control Commission

(2) In order to advise the Federal Health Agency, a Federal Health Conference can be set up, in which the main actors in the health care sector are represented.

(3) The Federal Health Agency is responsible for managing the business of the Federal Health Agency.

(4) The Contracting Parties shall ensure that the Federal Health Agency receives, on request, the data required for the performance of its tasks in an appropriately prepared and traceable form.

(5) In the performance of the tasks, the Federal Health Agency must in particular ensure that a high-quality, effective and efficient, all freely accessible and equivalent health care in Austria, in particular, also is ensured by the target control health and the financial viability of the Austrian health care system is secured in compliance with the financial framework agreements.

(6) The Federal Health Commission is chaired by the Federal Minister for Health. The Federal Minister of Health, the first chairperson-the first chairperson-deputy is headed by the Federal Minister for Health, the Federal Minister for Health, the Social Security and the second Chairperson-Deputy/Vice-Chairperson. Second Chairperson-Representative shall be appointed by the Länder.

Article 11

Federal Health Commission

(1) The Federal Health Commission shall belong to

1.

nine representatives of the federal government, nine representatives of the main association of the Austrian social insurance institutions and one representative/one representative per country, as well as

2.

One representative/representative per representative of the interests of the cities and municipalities, one representative/representative of the confessional hospitals, one representative/representative of the patient representatives and one representative/representative of the Austrian Medical Association.

3.

Non-voting members of the Federal Health Commission are each a representative/representative of the Federal Ministry of Science and Research, the Austrian Pharmacists ' Chamber, the General Accident Insurance Institution and the Federal Ministry for Economic Affairs and Social Affairs, § 149 (3) of the ASVG, BGBl. No 189/1955 in the current version, mentioned hospitals are the relevant legal representation of interests.

(2) A majority of votes and the approval of at least three quarters of the representatives referred to in paragraph 1 Z 1 are required for the resolutions of the Federal Health Commission.

(3) In the context of the planning, management and financing of the health care system in Austria, the Federal Health Commission has to deal with the provisions of the Federal-Target Tax Treaty and the Federal-Target Control Commission, as well as the German Federal Health Commission. , taking into account macroeconomic impacts and regional and country-specific needs. In the Federal Health Commission, decisions are made on the following points (decisions):

1.

on matters relating to the Federal Health Agency as a fund:

a)

Ongoing maintenance and updating as well as further development of the performance-oriented hospital financing model (LKF) including its fundamentals

b)

Guidelines for the use of earmarked funds of the Federal Health Agency in accordance with the provisions of Articles 30, 32, 33 and 45 of the Agreement in accordance with Art. 15a B-VG on the organisation and financing of the health care system in each of the Current version

c)

Financial statements and financial statements of the Federal Health Agency

2.

on general public health concerns:

a)

(Further) Development of the (framework) health objectives, including the definition of indicators and monitoring in accordance with Art. 4 (incl. Strategies for implementation)

b)

Framework requirements for the interface management between the various sectors of the health care system

c)

Development and development of information and communication technologies relevant to health (such as ELGA, eCard, Telehealth, Telecare)

d)

Guidelines for a nationwide comprehensive documentation of all sectors of the healthcare system, as well as further development of the documentation and information system for analyses in the health care sector (DIAG)

e)

Evaluation of the tasks carried out by the Federal Health Commission

Article 12

Federal-Target Control Commission

(1) The Federal Objective Control Commission shall comprise four representatives of the Federal Government, the Länder and the social security system.

(2) unanimity is required for decision-making in the federal-target steering committee.

(3) The draft federal government tax treaty is to be discussed in the Federal Government's target steering committee and recommended by common accord to the federal government, the main association of Austrian social security institutions and the countries for decision-making. This Treaty shall form the basis and the framework for the tasks referred to in paragraphs 4 and 5.

(4) The following points (decisions) shall be made in the Federal Target Control Commission:

1.

Coordination, voting, and stipulations of all of the federal-target tax treaty incl. Tasks resulting from the Financial Framework Agreement

2.

Annual work programmes for measures at the federal level for the concrete implementation of the federal target tax treaty

3.

Principles for nationwide monitoring of target control-health including financial control monitoring

4.

Matters relating to monitoring and reporting in accordance with Section 7

5.

Perception of agendas of the sanction mechanism in accordance with Section 8

6.

Issues arising from the framework for contractual and cross-sectoral financing and settlement mechanisms at the country level, to be responsible for social security and social security matters (e.g. B. Spitalsambulances, group practices and established specialist doctors, daily clinical care, innovative forms of care, etc.); Development, testing of billing models for cross-sectoral financing of the outpatient Range

7.

(Next) Development of remuneration systems

8.

Quality matters

9.

Principles, objectives and methods for planning in the Austrian structural plan Health/in the regional structural plans Health

10.

Affairs of the Austrian structural plan Health incl. Structural quality criteria in accordance with Articles 3 and 4 of the Agreement in accordance with Art. 15a B-VG on the organisation and financing of the health care system in the current version

11.

Planning of large equipment intra-and extramural

12.

Matters of the Medicine Commission

13.

Guidelines for the transparent presentation of the full budgeting and financial statements of the hospitals or institutions. Associations of hospitals and guidelines for the transparent presentation of the estimates and financial statements of the social security system for the extramural sector

14.

Development of projects for health promotion

15.

Evaluation of the tasks carried out by the German Federal-Government-Tax Commission

16.

Principles and objectives for the use of funds to strengthen health promotion in accordance with Article 23

(5) Information and consultation on the content and strategic definitions of the target orientation and the governance mechanisms of the Federal Government, the Länder and the social security system in the Federal Government's serve their respective scope of action.

Subsection B)

Decision structures and organization at the country level

Article 13

Organisation of the State Health Fund (pursuant to Article 18 of the Agreement pursuant to Art. 15a B-VG on the organisation and financing of the health care system in the current version)

(1) The following institutions shall be set up in the State Health Fund:

1.

Health Platform

2.

Country-Target Control Commission

(2) In order to prepare the meetings of the Health Platform and the Land-Target Control Commission, it is possible to provide for a Bureau consisting of representatives of the country and of the social security system.

(3) In order to provide advice to the State Health Funds, a health conference can be set up in which the main actors in the health care sector are represented.

(4) In order to carry out the tasks of the Land-Target Control Commission, an equal co-ordinator shall be appointed from the country and from the social security system, who shall be solely the co-chair of the The country of destination control commission shall be responsible for all matters referred to in Article 15. The management of the Land Health Fund is the responsibility of the country.

(5) The Contracting Parties shall ensure that, on request, the State Health Funds receive the data required for the performance of their tasks in a manner which is appropriately prepared and comprehensible. In addition, it is ensured that all relevant measures in the intra-and extramural area are informed in the institutions of the State Health Fund.

(6) In the performance of the tasks, the State Health Funds shall, in particular, ensure that a high-quality, effective and efficient, all freely accessible and equivalent health care in Austria, in particular, shall also: is ensured by the target control health and the financial viability of the Austrian health care system is secured in compliance with the financial framework agreements.

(7) In the event of a contractual condition with the contracting parties, the State Health Fund will help to avoid serious consequences for the population. It is also necessary to regulate the charges in the case of additional services. Social security has to pay to the State Health Fund at the most to the extent of the comparable savings in medical expenses.

(8) The chairmanship of the health platform shall be a member of the Land Government appointed by the Land. The first deputy of the chairperson is the Obwife/Obmann of the local area health insurance fund. A member of the Land Government appointed by the Land shall hold the chairmanship of the Land-Target Control Commission on an equal footing with the Obwife/Obmann of the locally competent Territorial Sickness Fund (Co-Chair). The Rules of Procedure shall ensure that the meetings are jointly prepared (agenda and documents) and that they are to be invited.

Article 14

State-of-the-art health platform

(1) The health care platform shall include:

1.

with voting rights: five representatives of the country and five representatives of the social security institutions as well as one representative/representative of the federal government; substitute members in accordance with the rules of the federal state law,

2.

without voting rights: the main association of Austrian social insurance institutions and

3.

In any event, representatives of the Medical Association, the interest groups of the cities and municipalities, the patient representatives and the legal entities of the hospitals, which are settled through the State Health Fund, to which the national law a right to vote can be granted.

(2) In the case of the representation of social security, respect for the rights flowing from the self-administration must be respected.

(3) As regards decision-making in the health care platform, the following shall apply:

1.

In matters referred to in paragraph 5 Z 1, subject to paragraph 9, there shall be a majority of the country.

2.

In matters referred to in paragraph 5 Z 2, a majority of votes and the consent of at least three quarters of the representatives referred to in paragraph 1 Z 1 shall be required.

3.

The Federal Government has a right of veto against decisions which violate applicable law, the applicable agreements pursuant to Art. 15a B-VG, the Federal Objective Tax Treaty or the decisions of the institutions of the Federal Health Agency.

(4) The health care platform at the state level has to plan, manage and finance health care in the state sector, subject to compliance with the provisions of the Federal Health Agency, in the federal target tax contract, in the respective The country's target tax treaty and the respective country-to-tax commission, as well as taking account of macroeconomic implications.

(5) The health platform shall be based on the following provisions (decisions):

1.

in matters of the State Health Fund as a fund:

a)

Country-specific development of the performance-oriented hospital financing system in force in the federal state; retribution of operating services of the fund hospitals; implementation of performance-based remuneration systems; Support for investment projects; grant of grants for projects, planning and hospital-relieving measures

b)

Progress and closure of the accounts of the State Health Fund

c)

Tasks to be transferred to the State Health Fund under national legislation under the jurisdiction of the country

2.

on general public health concerns:

a)

(Further) Development of the health objectives (incl. Strategies for implementation) at the country level

b)

Principles of the implementation of quality guidelines for the provision of intra-and extramural health care

c)

Principles of implementation of requirements for interface management

d)

Participation in the development and development of information and communication technologies (such as ELGA, eCard, Telehealth, Telecare) relevant to the health sector at the country level

e)

Implementation of projects on health promotion

f)

Evaluation of the tasks performed by the Health Platform at the country level

(6) Information and consultations shall be provided in the health care platform on the following points:

1.

Resource planning in the care sector

2.

Report on the Land of the Land-Target Control Commission

(7) The estimates and the financial statements are to be transmitted to the Federal Health Agency immediately after the decision has been taken.

(8) The national legislation may provide that individual tasks of the health platform, provided that there is agreement between the country and the social security system, can be transferred to the country-to-destination control commission.

(9) A share of EUR 15 million corresponding to the number of people in each country from the grants for hospital-relieving measures in accordance with the provisions of this Regulation. Paragraph 5 Z 1 lit. a is to be shown separately in the estimates in the years 2013 to 2022 in the estimates. The award of these funds will be decided on the basis of agreement between the country and the social security system in the health care platform.

Article 15

Country-Target Control Commission

(1) The Land-Target Control Commission shall include the Kurie of the Land with five representatives, the Curia of the Social Security institutions with five representatives as well as a representative of the Federal Government. In the case of the representation of social security, respect for the rights arising from the self-administration must be respected.

(2) With regard to the decision-making in the country's target steering committee, the following shall apply:

1.

Within the respective curia, a decision on their voting behaviour shall be brought about. The decision-making process is to be regulated for the course of the country by national law and for the curia of the social security institutions in the social security law.

2.

For resolutions, there is a need for agreement between the Kurie of the country and the curia of the social security institutions.

3.

The representative of the Federal Government has a right of veto against decisions which are contrary to applicable law, the agreements in force in accordance with Art. 15a B-VG, the Federal Objective Tax Treaty or the decisions of the institutions of the Federal Republic of Germany. Federal Health Agency in violation. In the event of the Federal Government being prevented from taking part in the session, the latter may, within one week, bring his/her right of veto in writing.

(3) In the respective country-target steering committee, the draft for the country-to-tax contract should be advised and recommended for decision-making in the relevant bodies of the social health insurance and the country by common accord. This Treaty shall form the basis and the framework for the tasks referred to in paragraphs 4 and 5.

(4) The following points are made in the Land-Target Control Commission (decisions):

1.

Coordination, votes, and stipulations of all from the country-target tax treaty incl. Tasks resulting from the Financial Framework Agreement

2.

Annual work programmes for measures at the country level for the concrete implementation of the country-Target tax treaty

3.

Participation in the nationwide monitoring and monitoring of the monitoring report in accordance with Section 7

4.

Perception of agendas of the sanction mechanism in accordance with Section 8

5.

Implementation of the rules for contractual and cross-sectoral financing and settlement mechanisms at the country level, which are responsible for social security and social security (e.g. B. Spitalsambulances, group practices and established specialists, daily clinical care, innovative forms of care, etc.); Implementation of agreed innovative models for cross-sector financing of the outpatient sector

6.

Matters relating to the regional structural plan Health pursuant to Articles 3 and 4 of the Agreement in accordance with Art. 15a B-VG on the organisation and financing of the health care system in the current version

7.

Matters of large-scale equipment intra-and extramural

8.

Strategy on health promotion

9.

Matters relating to the health promotion fund referred to in Article 23

10.

Participation in the implementation of quality guidelines for the provision of intra-and extramural health care services

11.

Implementation of requirements for seam management

12.

Evaluation of the tasks carried out by the country's target steering committee

(5) The country's target steering committee provides for mutual and timely information and consultation on the essential operational and financial matters relating to the provision of services in the healthcare sector in the country, and Social security.

Section 5

Concretization of the target-health partnership-Health

Article 16

Orientation of the target control-health

(1) On the basis of the principles and objectives of the target management health set out in Section 2, as well as those set out in the agreement under Art. 15a B-VG on the organisation and financing of the health care system, as amended, Regulations are the target control-health in the following four control areas

1.

Results orientation,

2.

Supply structures,

3.

supply processes and

4.

Financial objectives referred to in Section 6

shall be specified.

(2) Measurement variables and target values shall be defined for all target agreements covered by the control areas within the scope of the target control health.

(3) Federal, State and Social Security at the federal level. Land and social security at the country level are jointly responsible for the conclusion of the contract, the implementation of and compliance with the target tax health. This includes mutual information and consultation on the measures envisaged, which may be taken in the respective sphere of action and which may have an impact on the other supply sector. In order to implement the binding targets, the Federal Government, the Länder and the Social Security Council have to support each other in a comprehensive and mutually supportive way. In the event of a conflict, the respective target control commission must be dealt with in any case.

(4) The partners of the federal target tax treaty shall ensure that the existing target control systems in the field of public health are the federal target tax treaty and/or the federal government. do not contradict the country's target tax treaties.

Article 17

Result orientation control area

(1) In the steering field of results orientation, the federal target tax treaties must contain, in particular, the following provisions:

1.

National framework for results-oriented supply targets and impact-oriented health goals derived from the framework health objectives

2.

Documentation requirements (data base: cross-sector uniform diagnostic and performance documentation; pseudonymisation) for a nationwide monitoring of health and supply targets

3.

Nationwide uniform measures and target values for the measures that are defined in the control areas of supply structures and processes; these should also be used for international comparisons and performance measurements

4.

Uniform requirements for cost-benefit assessments and evidence-based basification (HTA) of diagnostic and treatment methods (incl. Health promotion, screening and vaccination programmes)

5.

Coupling of health promotion and prevention measures to impact-oriented health goals incl. mandatory evaluation

(2) Regional health and supply targets must be set in the country's target tax treaties, so that the nationwide targets for results-oriented supply targets and impact-oriented health goals can be achieved.

Article 18

Control Area Supply Structures

(1) In the area of control of supply structures, the federal target tax treaties must contain, in particular, the following provisions in the form of bandwidths:

1.

Demand-oriented supply and power density in the acute and outpatient (intra- and extramural) range (further development of the supply density in the direction of power density for all areas)

2.

Proportion of daily clinical performance or the outpatient service provision for specified selected services

3.

Discharge of the fully inpatient sector in the acute care hospitals through medical and macroeconomic relocation of services in the daily clinical and/or clinical trials. in the outpatient sector (hospital bullets, independent ambulatories and established areas), taking into account the provisions of Article 5 (3) (1), (2) and (3)

4.

Part of the outpatient care structure with opening hours at day-edge and weekend times and the proportion of interdisciplinary care models at the outpatient care structure

5.

Strengthening primary health care, including in the established sector

6.

Frame specifications for any affected seams

7.

Framework requirements for the role distribution, tasks and supply contracts of outpatient supply stages

8.

Crossborder cooperation

(2) Within the framework of the accrual country-related country-to-target tax contracts, the above-stated provisions set out in accordance with paragraph 1 shall be specified on the basis of regional needs and shall be determined by common agreement for the relevant period of observation. In addition, these Treaties provide for the implementation of action-related implementation in both qualitative and quantitative terms, with particular reference to the following measures concerning supply structures which have a significant impact on the environment. for the provision of services in the other sector, should be taken into account:

1.

Capacity adjustments in acute care institutions, in particular by setting structural measures such as transformation into (disloted) weeks and/or Day clinics and basic hospitals or work of hospital networks and hospitals with several locations (including: Definitions for the joint operation of selected functional areas)

2.

Capacity adjustments of extramural service provision (insb. interdisciplinary supply models such as (b) self-employed ambulatories, group practices or innovative forms of supply to be established; extended opening hours, taking into account regional supply contracts to be determined (especially in the case of new contracts)

3.

Establishment of interdisciplinary central reception and initial supply units and ambulant primary care units

4.

Planning of hospital bullets in connection with the established medical specialists

5.

Adjustment of the daily clinical and outpatient structures based on the agreed target performance volumes per area

6.

Determine the distribution of roles, tasks and supply contracts for each outpatient service level and binding cross-sectoral offer planning on the regional structural plans health (incl. Possibility of withdrawal of upright permits in the case of decommissioning of parallel structures)

7.

Setting "best points of service" by means of regional supply contracts differentiated according to the level of supply and the introduction of integrated supply models

8.

Consideration of the "forward waiting time" and "utility efficiency" per service provider in the regional capacity planning in the outpatient sector (RSG)

Article 19

Control Area Supply Processes

(1) In the control area of supply processes, the federal target tax contracts must contain, in particular, the following provisions as target agreements for the optimization of the treatment processes:

1.

Determination of the implementation of eHealth concepts (electronic health records, cross-sector uniform diagnosis and performance documentation, eMedication, etc.)

2.

Reduction of preventable double and multiple findings, especially in the case of elective interventions by the implementation of the federal quality guideline

3.

Comprehensive definition and implementation of quality standards (e.g. B. Federal Quality Guidelines for admission and dismissal management)

4.

Offer of disease management programs and concepts for integrated care

5.

Operational measures for the implementation of § 24 para. 2 third and fourth sentence KAKuG (The existing instruments for the implementation of an economic prescription are to be included in a binding manner.)

6.

Measures for the effective and efficient use of drugs

(2) On the federal level, a joint "Drug Commission" for the intra-and extramural area will be established as part of the target control-health, in particular for high-priced and specialized medications and their fields of application. Where:

1.

The task of the "Drug Commission" is to submit recommendations, at the request of a federal state or the main association of Austrian social insurance institutions, to the Federal-Target Control Commission, which are highly prize-winning and specialized drugs in which supply sector are used and which cost-reimbursement system or which supply sector will be responsible for the costs incurred. Their recommendations have to be based on the "best point of service" and in particular on medical-therapeutic, health-economic and supply-oriented aspects, in order to achieve the highest possible quality of service to ensure.

2.

The joint "Drug Commission" for the intra-and extramural sector includes three representatives from the Social Security and the Länder. The chair is chaired by a representative of the federal government. The Federal Minister for Health sends three designated scientific experts in the pharmaceutical sector to the Commission. All members shall be entitled to vote. The recommendations shall be made with three-quarters majority, with the minority opinion being documented on request.

3.

The Federal Government of the Federal Republic of Germany has to decide on the recommendations of the joint "Drug Commission" for the intra-and extramural sector.

4.

The Heilmittel-Evaluation-Commission, established by the Austrian Social Insurance Institutions, will continue to prepare the decisions of self-government in the procedures relating to the refund code, in which they will be included in the In any case, recommendations to the main association of Austrian social insurance institutions have to be taken by the decisions of the German Federal Government's tax commission.

(3) In the country-to-target tax treaties, measures must be taken to optimise the treatment processes by improving organisational and communication processes between all service providers. In particular, such measures shall be considered:

1.

Implementation of eHealth concepts (electronic health records, sector-by-sector standardized diagnosis and performance documentation, eMedication, etc.)

2.

Implementation of (intersectoral) guidelines and standards (e.g. Admission and dismissal management, pre-operative diagnostics) for treatment and care in particular for chronic and frequent diseases

3.

Patient control to the "best point of service"

4.

Implementation of evidence-based and quality-assured disease management programs as well as integrated supply concepts

Article 20

Preferences and content of the country-Target tax treaties

The country's target tax treaties must not be contrary to the federal government's target tax treaty. On the basis of regional requirements, they must specify in particular the requirements of the federal target tax treaty in the control areas "outcome orientation", "supply structures", "supply processes" and "financial targets", and the appropriate measures for implementation.

Article 21

Annual work programmes

The definitions and measures taken in the target control contracts in the "Results Orientation", "Supply Structures", "Supply Processes" and the Financial Objective Control (Section 6) control areas are in view of their timely Implementation to be operationalized. Annual programmes shall be drawn up for this purpose.

6.

Determination of financial target management

Article 22

Financial Objective Control-General provisions

(1) The Contracting Parties agree to be present in the 5. To supplement the specific areas of control with a financial target control as an integral part of the target management-health. The financial target control is to be specified in financial framework contracts at the federal and state level, which are part of the accrual-related federal and state-to-target tax treaties.

(2) The basis of financial target control shall be a cross-sectoral expenditure-fighting path to be agreed upon. This expenditure attenuation path includes a forecast of health expenditure without intervention, the agreed nominal expenditure ceilings for public health expenditure (excluding long-term care) and the resulting damp effects in the case of Expenditure growth (expenditure control effects). These expenditure ceilings and expenditure control effects are to be presented both at federal and national level in the field of social security and in the area of countries, and at national level on cross-sectoral expenditure ceilings and to merge output attenuation effects.

(3) The contractual partners shall constitute, on the basis of financially assessed and comprehensible assumptions, a package of measures, which is appropriate in total, the agreed expenditure ceilings and the resulting expenditure control effects actually to the public. Finally, the final achievement of objectives is based on compliance with the respective ceilings for expenditure.

(4) At the federal level, the following criteria shall be used for the determination of the expenditure fighting path:

1.

The increase in public health spending is gradually dampening in the first period of target control-health from 2012 to 2016 to the extent that annual spending growth in 2016 is 3.6 percent (average) Development of nominal gross domestic product in accordance with the medium-term forecast for the Federal Financial Framework Act). In the further periods, the annual increase in expenditure is linked to the average development of the gross domestic product according to the medium-term forecast for the Federal Financial Framework Act, in the version in force.

2.

In 2016, an expenditure dampening effect of 1.3 billion euros is to be achieved, resulting in an expenditure ceiling for public health spending in 2016 of a total of 25.563 billion euros.

3.

For the first period of target control-health from 2012 to 2016, cumulative spending dampening effects of a total of 3.43 billion euros are to be achieved.

(5) In the following periods, in particular for the period up to 2020, binding values for the quantities referred to in paragraph 4 (4) (1) to (3) and the possible change in the methodology for the determination of these values in the federal target tax treaty are to be established. In this connection, the agreement in accordance with Art. 15a B-VG on the organisation and financing of the health care system must be taken into account in the current version.

(6) Compliance with the expenditure control path at the federal and state level must be ensured by means of mutually agreed measures of measures within the framework of the target control-health.

(7) The identification of health expenditure in the area of countries and social security, as defined in the context of financial target control, must be determined in a transparent and comprehensive way. The methodology of the Austria-wide presentation and the initial figures for the first period of the target control-health are set out in Articles 26 and 27. The accounts required for the determination of public health expenditure and for the subsequent monitoring shall be mutually open and the corresponding data shall be identified.

(8) Health expenditure in the area of pension insurance, accident insurance, health care institutions and the federal government as well as investments are to be presented separately.

(9) Financial objective control refers to the use of funds. The relevant provisions relating to the future of the budget, in particular those laid down in the agreement referred to in Article 15a B-VG on the organisation and financing of the health system, as amended, shall be maintained by the Target control-health is unaffected.

(10) In the case of the implementation of financial target management, it is at least necessary to ensure that social health insurance is aimed at a revenue-oriented expenditure policy.

Article 23

Strengthening health promotion

(1) In order to strengthen health promotion and prevention, special funds with their own constituency as the so-called "health promotion fund" without legal personality are to be set up in all the State Health Funds.

(2) This health promotion fund for 10 years (2013 to 2022) will be endowed with a total of EUR 150 million in Austria, with a total of EUR 130 million through social security and EUR 20 million by the countries in the same period. To be involved in years. The social security funds are allocated according to the insurer's key, the funds of the countries are applied according to the number of people and distributed in this form to the federal states.

(3) At the country level, the decision on the use of funds from the health promotion fund in the country's target tax commission in agreement between the country and the social security system shall take place.

(4) The funds not used in the financial year shall be allocated in the following year to the available health promotion funds.

(5) The Federal Commission for the Control of Health has to adopt principles and objectives for the use of these health promotion funds, in particular ensuring that health promotion projects are subject to the basic objectives of the Federal target tax treaty and the country's target tax treaties do not contradict.

Article 24

Content and subject of the financial framework contracts

(1) The financial framework contracts at the federal and state level shall determine the expenditure ceilings and the expenditure control effects derived therefrom. These include the health expenditure to be held by the contracting parties in the context of the taxation of objectives, which will in future be subject to a joint financial responsibility of countries and social security in terms of the use of funds, as in the case of Article 22 of this Regulation shall apply.

(2) At the federal level, the financial framework contracts for the respective period of the target control health shall, in any case, include the following content:

1.

For the nationwide cross-sectoral spending fight path of public health expenditure without long-term care:

a)

the initial value for the first year of each period

b)

expenditure development in the period without intervention

c)

the annual expenditure ceilings and the resulting annual expenditure ceilings

d)

Annual and cumulative expenditure attenuation effects, as well as

e)

The allocation key for the expenditure control effects on the two sectors

2.

For the nationwide sectoral spending attenuation paths of the current public health expenditure relevant for financial target management:

a)

the initial values for the first year of the respective period

b)

expenditure development in the period without intervention

c)

the annual expenditure ceilings and the resulting annual expenditure ceilings

d)

Annual and cumulative expenditure attenuation effects according to Z 1 lit. d and e

Separately for countries and social security

3.

The division of the one in Z 2 lit. c and d Expenditure Ceilings and Expenditure Control Effects Derived Therefrom

a)

to the nine federal states

b)

all social health insurance institutions and the

c)

country-by-country merger of lit. B

4.

To be presented separately:

a)

Investment

b)

Health expenditure of pension insurance (in particular rehabilitation)

c)

Health expenditure of the accident insurance

d)

Health expenditure of the health care institutions

e)

Health expenditure of the federal government

5.

The specific design of the differentiated statement of expenditure for the extra-and intramural sector as well as the generation of the necessary data bases is to be agreed in the first federal-target-control contract.

6.

Furthermore, in the first federal target tax contract, the content-based nationwide framework regulations for the financing and clearing mechanisms to be provided at the country level in accordance with paragraph 3 Z 7 for agreed cross-sectoral agreements are To agree performance shifts.

(3) At the national level, the financial framework contracts for the respective period of the target management-health for all nine Länder in any case shall include the following content:

1.

Presentation of the expenditure attenuation path of the current public health expenditure of each country relevant to the financial target control:

a)

the initial value for the first year of the respective period

b)

expenditure development in the period without intervention

c)

the annual expenditure ceilings and the resulting annual expenditure ceilings

d)

Annual and cumulative expenditure attenuation effects according to paragraph 2 (2) (3) (lit). A

2.

Presentation of the expenditure attenuation path of the current public health expenditure of social security in the country in question, relevant for financial target management:

a)

the initial value for the first year of each period

b)

expenditure development in the period without intervention

c)

the annual expenditure ceilings of the social security system and the deducted from it

d)

Annual and cumulative expenditure attenuation effects according to paragraph 2 (2) (3) (lit). C

3.

The representation of the merged output fight path according to Z 1 and Z 2 for the respective state

4.

The investment in the respective Land separately by country and social security

5.

The outputs of both sectors are presented according to a functional structure based on a federal report template: For the extramural sector, a differentiated presentation of the expenditure according to the previous the functional structure. In any case, a differentiated presentation of the main funding positions of the State Health Fund and of the Länder/municipalities is to be made for the intramural sector. In addition, for the intramural sector, based on the estimates and financial statements of the hospitals, and on the basis of the nationwide uniform data bases for the hospitals-cost accounting is one for material. and functional aspects differentiated from these calculators, derivable expenditures-or Cost presentation (expenditure/costs for personnel, medical and non-medical products and consumer goods, including a separate presentation of the cures, medical and non-medical services, and for medical and non-medical services, and for the use of medical and non-medical services) investments) to be defined and supplemented. A differentiated representation according to functional and specialist areas is to be sought.

6.

The measures agreed in the country's target tax treaties shall be presented in financial terms as follows:

a)

Overall assessment of the measures presented in accordance with Article 17 (2), Art. 18 (2) and Article 19 (3) and

b)

their effect on the intra-and extra-mural range.

7.

Binding rules for cross-sectoral financing and settlement in accordance with paragraph 2 (2) (6) of performance shifts caused by the health of the target. from newly established supply forms

Article 25

Determination of the spending fight path for the first period at the federal level

(1) The initial basis for the determination of nominal expenditure ceilings, including expenditure attenuation effects at the federal level, as well as for the definition of sectoral and regional expenditure ceilings for the first period of 2012 to 2016, are the Public health expenditure 2010 in its respective form, taking advantage of demarches in analogy to the approaches of Statistics Austria on the basis of "Systems of Health Accounts (SHA)".

(2) The effects of expenditure damping are derived from the difference between the forecast of public health expenditure without intervention and the expenditure ceilings for approximation to the GDP path.

(3) Starting from public health expenditure without long-term care (ÖGA) in 2010 in the amount of 20,262 million euro, a rise in public health expenditure for the year 2011 will be based on 3.3%. This results in an initial value for 2011 in the amount of 20,931 million euros.

(4) For the forecast of health expenditure without intervention, an annual increase of 5.22% for the years 2012 to 2015 and 4.65% for 2016 will be taken as a basis.

(5) From the gradual approach to the projected GDP path in accordance with Art. 22 (4) (1) (1), the following expenditure attenuation path is to be obtained for the years 2012 to 2016:

Amounts in million Euro

2012

2013

2014

2015

2016

Expenditure development Public health expenditure without intervention

22.024

23.175

24.386

25.660

26.853

Expenditure ceiling

21.873

22.813

23.748

24.675

25.563

annual expenditure damping effects (rounded)

150

360

640

980

1.300

Article 26

Determination of the expenditure fight path for the first period in the countries

(1) Countries undertake to achieve cumulative expenditure for expenditure on public health expenditure of EUR 2,058 million in the first period to 2016.

(2) Based on this, for the first period up to 2016 the following expenditure for the expenditure of public health expenditure on public health expenditure for the countries is to be realized:

2012

€ 90 million Euro

2013

€ 126 million Euro

(cumulative: € 216 million) Euro)

2014

€ 168 million Euro

(cumulated: 384 million) Euro)

2015

€ 204 million Euro

(cumulative: € 588 million) Euro)

2016

192 million Euro

(cumulative: € 780 million) Euro)

Cumulated expenditure for the countries to be used by 2016:

€ 2,058 million Euro

(3) The expenditure damping effects as set out in paragraph 2 shall be achieved by the countries on the basis of the current health-related expenditure of the State Health Fund-financed hospitals (FKA). The initial values relevant to the target tax are derived from the financial statements of the State Health Fund and/or to derive the countries and municipalities as follows (see Annex):

Expenditure for fund hospitals (FKA) according to the annual accounts (RA) of the Landeshealthfonds (LGF) (incl. of the funds under the Health and Social Sector-Aid Law (GSBG))

Breeder: Investment (incl. Debt services for investment)

Breeder: Structural Funds

Breeder: LGF-designated operating departure cover

Breeder: foreign guest patients

Breeder: other cost contributions

: Target-control-relevant outputs for FKA according to RA of the LGF

Zuzügl. Operating cover identified in the RA of the owners or Public Carrier (insb. Countries and municipalities)

Zuzügl. Municipal operations coverings (if relevant)

Breeder: Operating expenses cover/operating grants for nursing homes (if relevant)

Zuzügl. Social assistance (if not included in RA of the State Health Fund)

: Target tax-related health expenditure in the area of the countries

(4) expenditures of the State Health Fund for funds under the Health and Social Welfare Area-Aid Act (GSBG) are included in the initial values relevant to the target control. In any case, this expenditure position shall be subject to a separate analysis in the context of the financial objective control monitoring. Any changes resulting from the GSBG funds resulting from changes in tax obligations, in particular in the case of staff settlements between local authorities and hospitals, shall remain in the determination of the performance of the Expenditure ceilings are not eligible.

(5) A modification of the presentation of the financial statements of the State Health Funds as well as of other underlying accounts of a country, provided that the target control-health of relevance is relevant, are compared with the partners of the To make target control-health transparent. In any case, a time series continuity in the positions relevant to the financial objective control is to be ensured and, in the event of any changes, it is necessary to ensure this continuity with the parties in the Federal Target Control Commission. To establish agreement.

(6) For 2010, for the countries concerned, an initial value of 9,320 million euro is defined as target-related health expenditure; for the year 2011, taking into account the increase of 3.3% as a basis, a value of EUR 9,627 million.

(7) In the first period up to 2016, the following expenditure ceilings, including expenditure control effects, are thus obtained for the Länder, with the implementation of the objectives being in the foreground in the period:

Year

Defined output values of the countries for financial target control, without spending attenuation (nationwide)

Sum of countries ' expenditure fights

Expenditure ceilings of the Länder (nationwide)

2012

€ 10.130 million

€ 90 million

€ 10.040 million

2013

€ 10.659 million

€ 216 million

€ 10,443 million

2014

€ 11.215 million

€ 384 million

€ 10.831 million

2015

€ 11.801 million

€ 588 million

€ 11.213 million

2016

€ 12.349 million

€ 780 million

€ 11.569 million

Overcrowds in the expenditure control effects of the countries in one year can be credited to the following years, provided that the annual expenditure ceilings established are complied with.

(8) The distribution of expenditure ceilings, including the effects on expenditure to be achieved within the countries, must be carried out by the Länder and documented in the federal and national tax treaties (decision of the National Finance Conference of 2 October 2012).

Article 27

Determination of the expenditure attenuation path for the first period in the field of social security

(1) The federal government has to ensure that social insurance institutions in the first period to 2016 achieve cumulated spending dampening effects of public health expenditure in the amount of 1,372 million euros.

(2) Based on this, for the first period up to 2016 the following expenditure control effects of public health expenditure for social security are to be realized:

2012

€ 60 million Euro

2013

€ 84 million Euro

(cumulative: 144 million) Euro)

2014

€ 112 million Euro

(cumulative: € 256 million) Euro)

2015

136 million Euro

(cumulative: EUR 392 million). Euro)

2016

€ 128 million Euro

(cumulative: 520 million) Euro)

Cumulative share of social security expenditure up to 2016:

€ 1,372 million Euro

(3) The expenditure damping effects as set out in paragraph 2 shall be achieved by the social security system on the basis of current expenditure. The basis for the social security expenditure relevant expenditure shall be the financial statements of the social insurance institutions, with the following percentages of expenditure to be deducted for the determination of the relevant initial values (see Annex):

1.

Transfers to the State Health Fund

2.

Transfers for the Private Sickness Fund (PRIKRAF), accident and other hospitals and Hanusch hospital

3.

Inpatient rehabilitation

4.

Health consolidation and disease prevention (Kuren)

5.

Cash benefits (sickness benefit, weekly allowance, funeral expenses allowance)

6.

Depreciation

7.

Financial expenses

8.

Transfers to the compensation fund

9.

Other extraordinary expenses

10.

Assignment of reserves

(4) Modifications of the presentation of the financial statements of the social security insurance, insofar as these are relevant for the purpose of controlling health, shall be made transparent. In any case, a time series continuity in the positions relevant to the financial objective control is to be ensured and, in the event of any changes, it is necessary to ensure this continuity with the parties in the Federal Target Control Commission. To establish agreement.

(5) For social security, an initial value of EUR 8.146 million is defined as target-related health expenditure for the year 2010; for the year 2011, this results in taking into account the increase of 3.3% on the basis of the above-mentioned increase in the total amount of the total amount of the total amount of the total amount of the a value of 8,415 million euros.

(6) In the first period up to 2016, the following expenditure ceilings for social security are thus obtained, including expenditure damping effects, with the implementation of the objectives being in the foreground in the period:

Year

Defined output values of SV for financial target control, without spending attenuation (nationwide)

Total expenditure attenuation of SV

Expenditure ceiling of SV (nationwide)

2012

€ 8.854 million

€ 60 million

€ 8.794 million

2013

€ 9.316 million

€ 144 million

€ 9.172 million

2014

€ 9.802 million

€ 256 million

€ 9.546 million

2015

€ 10.314 million

€ 392 million

€ 9,922 million

2016

€ 10.794 million

€ 520 million

€ 10,274 million

(7) The distribution of expenditure ceilings, including the expenditure on expenditure to be achieved within social security institutions, and the allocation of expenditure ceilings and expenditure control effects in a country-by-country basis, are provided by the Social insurance and to document in the federal and respective country-target tax contracts.

Article 28

Virtual Budget

(1) The common financial responsibility at the country level within the framework of the virtual budget relates to the financial framework agreements to be agreed in accordance with Art. 24 and includes:

1.

the effect of expenditure and expenditure ceilings; and

2.

the measures in accordance with Art. 22 (3).

(2) The contents according to paragraph 1 (1) (1) are regulated in Article 22 (3) and Article 24 (3) (3) (1), (2) and (3).

(3) The contents according to paragraph 1 (2) are regulated in Article 22 (3) and Article 24 (3) (3) (6) and (7).

(4) For the purposes of Article 16 (3), country and social security insurance are jointly responsible for the implementation of the objectives agreed in the financial framework contracts, with the appropriate action in the case of non-fulfilment of objectives and in the case of infringements of the objectives of the financial framework. Financial framework contracts are regulated in Articles 34 and 35.

Section 7

Definitions for monitoring and reporting

Article 29

Implementation of a monitoring and reporting system

(1) In the target control system health, the agreed objectives shall be defined at the federal and state level in such a way that a running monitoring of clearly defined measured variables and target values is possible. A uniform evaluation scheme is also to be ensured in order to assess the degree of achievement of the target achievement.

(2) The partners of the target control-health have to implement a differentiated Austria-wide monitoring and reporting system at the federal level, differentiated according to sectors and regions. This reporting system must meet the following requirements:

1.

Monitoring of the operational objectives of the target control-Health on the basis of the contractually agreed measures of measurement and target values

2.

Creation of transparency and comparability

3.

Structured public reports

(3) The federal and state governments ensure that the data necessary for the monitoring and the evaluation based on it are made available in a timely way. The Länder agree that, in accordance with Section 17 (2) of the Federal Statistics Act 2000, the Federal Ministry responsible for Health is responsible for monitoring all of its data used by Statistics Austria for the purposes of the calculation according to the system of Health Accounts (SHA) are permanently provided directly by Statistics Austria.

Article 30

Process steps

The monitoring and reporting system must be carried out in the following process steps which are clearly separated from each other:

1.

The monitoring (data collection, processing and evaluation) is carried out by the health Austria GmbH. The data obtained in this way, together with the preparation and evaluation, must be sent to the respective country-to-destination control commission for its opinion.

2.

The respective country-target steering committee has to draw up recommendations for action.

3.

The approval of the monitoring report, including the recommendations for action, is carried out in the light of the statements made by the German Federal Government's tax commission.

4.

The Federal Target Control Commission has to submit the monitoring report, including the recommendations on action and the opinions to the country's target steering committees.

Article 31

Financing of monitoring and reporting

The funding of the monitoring-health and reporting-to be implemented at the federal level is carried out by the federal government.

Article 32

Detailed rules for monitoring and reporting

(1) The detailed rules for the monitoring and the evaluation based on it, in particular with regard to the necessary data, their form and data sources, are to be agreed in a binding manner in the first federal target tax treaty. These rules shall be regularly adapted to the requirements arising from the health of the target, in particular with a view to ensuring the availability of data. In any case, these detailed rules shall ensure that:

1.

the handling of the monitoring and the evaluation based on it is simple and easily possible,

2.

Primary use of existing routine documentation and data reporting

3.

Nationally accordized uniform measurement variables are used, and

4.

ensuring a high level of timeliness.

(2) The periodicity of the monitoring and the evaluation based on it shall be based on the essential measures and target values for the supply (in accordance with the control areas in Section 5) and the financial target control (corresponding to section 5). 6) to be regulated in the federal target tax treaty.

8. Section

Rules on the sanction mechanism

Article 33

General

(1) The Federation and the Länder agree to establish a sanction mechanism for the following cases:

1.

Non-fulfilment of objectives set out in this Agreement, in the Federal-State Tax Treaty or in the Land-to-Target Control Agreements, as a result of the monitoring

2.

Violation of this agreement, the federal target tax treaty or the country-target tax treaties

3.

Non-implementation of the Federal-Target-Tax Treaty or the Land-Target-Control Contracts

(2) The sanction mechanisms established in other agreements pursuant to Art. 15a B-VG shall remain unaffected by the arrangements made in this section. Financial sanctions for the non-achievement of financial targets are subject exclusively to the agreement between the Federal Government, the Länder and the municipalities via an Austrian Stability Pact 2012, BGBl. I No 30/2013.

Article 34

Arrangements for non-achievement of defined objectives

If, in the course of the monitoring by the Federal Target Control Commission, it is established that the objectives laid down in this agreement, in the federal target tax treaty or in the country's target tax contracts, have not been reached, the following shall apply: The following:

1.

In the event of a non-achievement of the common objectives laid down in the Federal-Target Tax Treaty at the country level, the respective country-of-destination control commission in whose country the objective has not been achieved shall, within eight weeks of the date of the determination of the Not-to submit a written report to the objectives of the German Federal Government's Target Control Commission. If the non-submission concerns the Federal Government, the obligation to report to the Federal Steering Committee is to be taken by the Federal Government.

2.

In the event of non-achievement of the common objectives laid down in the country's target tax treaties, the respective Land-Target Control Commission has within eight weeks of determining the non-achievement of the objectives of the Federal-Target Tax Commission a to submit a written report.

3.

In any event, the reports referred to in Z 1 and 2 shall contain the reasons for not achieving the objectives set and those measures to be taken to ensure the achievement of the objectives at the earliest possible date.

4.

The Federal Target Steering Committee has to approve the reports referred to in Z 1 and 2, in particular with regard to the proposed measures and the proposed timetable for achieving the objective. In the case of non-authorisation, revised reports shall be submitted.

5.

Approved according to Z 4 by the Federal-Target Control Commission. not approved reports shall be published with the appropriate commentary of the Federal-Government-Tax Commission and with the opinion of the respective parties concerned.

Article 35

Regulations for violations of this agreement, the federal target tax treaty, or the country-target tax treaties

(1) If, from the point of view of a contractual partner of the target control health, there is a violation of this agreement or against the federal target tax contract, this breach shall be by this contractual partner in the Federal-Target Control Commission in writing and justifies. The violations identified are to be dealt with in the Federal Target Control Commission and, in the event of a breach by the Federal Commission of the Tax Commission, it will be possible to take immediate action to restore the agreement, or to restore the agreement. to initiate contracts that are in conformity with the contract.

(2) If, from the point of view of a contracting party of a country-target-control contract, there is a breach of this country-target-tax contract, that breach shall be written and justified by this contractual partner in the Land-Target Control Commission. to show. The violations identified are to be dealt with in the country's target tax commission and, in the case of identified violations by the country's target steering committee, immediate action to restore the conformity of the contract is State in the way.

(3) Within a period of two months, the Federal Government of the Federal Republic of Germany and/or the Federal Government of Germany in the country's target tax commission, do not reach agreement on whether there is a breach or on the measures to be taken, the contracting party responsible for the infringement may initiate the dispute settlement procedure in accordance with Article 37.

(4) If additional expenditures result from a violation of the Federal-Target Tax Treaty or the Land-Target-Tax Contracts established by the dispute settlement procedure, these are to be borne by the contractual partner. The resulting additional expenditure shall be allocated to the expenditure of the contractual partner which is relevant to the financial purpose of the contract.

Article 36

Regulations for non-implementation of the federal government tax treaty or the country-to-target tax treaties

(1) It is up to the point in Section 3 (Art. 8 (4) (3) (3) of this Agreement, no subject-specific country-to-destination tax contract may be submitted. On a reasoned request from the respective Land-Target Control Commission, a reasonable grace period may be required for the submission of the Country-to-target tax treaty is granted by the federal government. The Federal Target Control Commission is to be informed about this.

(2) The following shall continue to be concluded within the time limit laid down for the country to which the country of destination is not subject:

1.

In the country's target steering committee, the consensus and dissent points are to be determined and to be presented to the Federal Target Control Commission.

2.

The federal target steering committee has guidelines for action with regard to the existing dissent points and/or points of interest. to determine the missing points to be deducted from the federal target tax contract.

3.

The Federal Commission of the Federal Government has made a report on Z 1 and 2 transparent by publication. The opinions of the parties concerned shall be fully integrated.

(3) It is up to the point in Section 3 (Art. 8 (3) (3) (3) of this Agreement, the following shall not be deemed to have been subject to a federal target tax treaty after a failure to comply with a grace period of 2 months:

1.

Consensus and dissent points are to be noted and made transparent by publication in the Federal Target Control Commission.

2.

If no federal tax treaty comes into effect within three months of publication, the Federal Minister of Health shall have a time-limit for a year in which the existing dissent points and/or the existing dissent points, respectively, shall be subject to action. to set any missing points at most. In the event of a financial impact, the agreement with the Federal Minister for Finance shall be established. In the course of these provisions, the Federal Minister for Health has assumed the preliminary work already in existence and of the guidelines which are in line with the action and which are suitable for achieving the essential objectives.

Article 37

Dispute settlement procedure for disputes arising from the federal target tax treaty or the country-Target tax treaties within the framework of the target control-Health

(1) In the case of disputes arising from the Federal-State Tax Treaty or the Land-Target Control Contracts, a Schlichtungsstelle is set up at the Federal Ministry of Health in connection with the target control-health.

(2) The Schlichtungsstelle (Schlichtungsstelle) shall belong to the following four-year-old members:

1.

A designated/appointed and independent/independent health expert appointed by the Federal Government of the Federal Government and/or appointed and independent/independent health expert as Chairman

2.

Two members sent by the Federation

3.

two members jointly dissent by the countries

4.

Two members sent by the main association of Austrian social insurance institutions

For decisions of the Schlichtungsstelle, the simple majority is required, whereby all members have one vote each, in the case of decisions on disputes arising out of the country-target tax treaties the members sent by the federal government do not have any Right to vote.

(3) If the Schlichtungsstelle (Schlichtungsstelle) is called by a contracting party, it shall decide on the matter and make this decision transparent by publication, in consultation with the contractual partners concerned. This decision shall be recognised by the contracting parties concerned. The Schlichtungsstelle shall have this decision

1.

the contracting parties concerned, and

2.

the Federal-Target Control Commission, and

3.

the respective country-the target tax commission in the case of disputes arising out of the country-the target tax treaty

to be taken into account.

Section 9

Corner points for statutory regulations for the establishment of target control-health both at federal and state level

Article 38

Legal regulations at federal level

(1) In order to ensure the establishment and implementation of the target-management-health partnership, the Federal Government has, in particular, to provide for the following statutory regulations:

1.

Obligation of social security to comply with the principles, objectives and fields of action of the target tax health, which are laid down in particular in sections 5 and 6

2.

Commitment of social security together with federal and state governments to use digital information systems from the eHealth sector to strengthen the health literacy of the population

3.

Anchoring of the binding sub-production of the federal-target-control contract by the main body after the decision of the carrier conference

4.

Regulations for financing and settlement mechanisms as well as for projects based on target tax contracts, in particular for cross-sectoral financing of the outpatient sector

5.

Determination of the changed organs (composition, decision-making and allocation of tasks) of the Federal Health Agency and of regulations for the secondment of representatives of social security to the institutions at federal and state level. National level and regulations governing internal decision-making within the social security system

6.

Commitment of the Federal Government, the Länder, the State Health Fund, the Social Security and the Health Service Provider, all for the target control-Health incl. To document the data required for monitoring and to provide the partners of the target control-health in a correspondingly prepared and comprehensible form

7.

Creation of the legal basis for national monitoring and the evaluation based on it

8.

Provisions for the sanction mechanism

(2) The Federal Government undertakes to carry out the statutory provisions in accordance with paragraph 1 as well as the necessary other federal legal adaptations in good time.

Article 39

Legal regulations at the state level

(1) In order to ensure the establishment and implementation of the partnership objective management health, the countries concerned must provide for the following statutory provisions:

1.

Obligation of the State Health Fund to comply with the principles, objectives and fields of action of the target tax health, which are laid down in particular in sections 5 and 6

2.

Commitment together with federal and social security systems to use digital information systems from the eHealth sector to strengthen the health competence of the population

3.

Determination of the amended institutions (composition, decision-making procedures and allocation of tasks) of the State Health Fund

4.

Provisions for the sanction mechanism

(2) The Länder undertake to implement the statutory provisions in accordance with paragraph 1 as well as the necessary other national legal adaptations in good time.

Section 10

Other provisions

Article 40

Special provisions for the event of natural disasters or exceptional emergency situations

In the event of natural disasters or exceptional emergencies, which are beyond the control of the State and significantly impede the financing of health care, balancing financing mechanisms should be agreed.

Article 41

Federal support obligation

Substantial additional expenditure (in analogous application of the agreement according to Art. 15a B-VG on a consultation mechanism, BGBl. I n ° 35/1999) of the Länder, on the basis of legal requirements imposed by the Federal Republic of Germany, shall be separately recorded and shall not be taken into account in the determination of the fulfilment of the expenditure ceilings in the countries concerned.

11.

Duration and final provisions

Article 42

entry into force

This Agreement shall enter into force after the announcement by the Federal Ministry of Health of all Contracting Parties ' communications that the provisions of the Agreement shall be adopted in accordance with the Federal the conditions necessary for entry into force in accordance with the country's constitutions are met by 1. Jänner 2013 in force.

Article 43

Implementation of the agreement

(1) The necessary federal and state regulations for the implementation of this agreement are retroactive with 1. Jänner 2013 in force.

2. The Contracting Parties agree to also provide for the following arrangements in the context of the transformation of this Agreement:

1.

An appointed member of the KAKuG-Novelle, BGBl. No 101/2007, the Federal Health Commission is a member of the Federal Health Commission which is to be set up under this agreement until another member is appointed for the purpose of this agreement.

2.

Decisions of the Federal Health Commission established with this KAKuG-Novel and derived rights and liabilities shall remain in place, provided that the Federal Health Commission to be established under this Agreement, or Federal-Target Control Commission does not decide anything to the contrary.

3.

The Federal Health Agency/State Health Fund is entitled to a recourse against members of the Federal Health Commission/State Health Platforms and members of the Federal Target Control Committee/Country-Target Control Commissions. Law on the liability of civil servants (BGBl. No. 80/1965 i.d.F. BGBl. No 169/1983).

Article 44

Duration, external force

(1) This agreement shall be concluded indefinitely. Until 31 December 2014, the Contracting Parties shall renounce their right to terminate the agreement.

(2) After 31 December 2014, this Agreement may be terminated by the Federal Government or at least six countries at the end of the year, subject to a period of nine months ' notice.

(3) The agreement shall not enter into force if:

1.

the agreement in accordance with Art. 15a B-VG on the organisation and financing of the public health system, without the successor arrangements accepted by the Federal Government and the countries, shall not enter into force; or

2.

the agreement in accordance with Art. 15a B-VG between the Federal Government, the Länder and the Municipalities via an Austrian Stability Pact takes effect in 2012, without the successor arrangements accepted by the Federal Government and the Länder.

(4) The agreement partners undertake to enter into timely negotiations on the adaptation of this agreement to amended EU legislation, with a view to the timely entry into force of the revised agreement and of any possible consequences of the agreement. supplementary national and national legislation.

Article 45

Communications

The Federal Ministry of Health shall inform the Contracting Parties without delay as soon as all notifications have been received in accordance with Art. 42.

Article 46

Original

This Agreement shall be drawn up in a single original. The original text will be deposited with the Federal Ministry of Health. This has to transmit certified copies of the agreement to all the contracting parties.

The agreement is in accordance with Art. 42 with 1. Jänner entered into force in 2013.

Faymann