KOSTELKA: UPPER LIMIT OF 2% OF INCOME FOR EXPENDITURES ON MEDICATION SHOULD APPLY TO EVERYONE

Especially the chronically ill are in need of many medicaments. That is why in 2008 an upper limit for prescription charges was introduced. Nobody should have to spend more than 2% of their income for prescription charges. Nevertheless, the Ombudsman Board has received many a complaint due to a loophole of the regulation.

This was illustrated by the particular case of a 71-year-old Viennese. For some years, Mr. N. N. has suffered from a chronic disease of the blood building cells in the bone marrow and has overcome several surgeries to the digestive tract, as well as a cardiac infarction. Nearly every week he is in need of fresh supply of medication in order to avoid exacerbation. Furthermore, he needs special medicaments to treat a severe skin disease.

All this amounts to a considerable financial burden. He had been happy about the introduction of the upper limit for prescription charges three years ago, but realised soon enough, that he could not reach this limit in spite of all his expenditures. When he requested an annual overview from his apothecary, he discovered the difference in prescription charge and so called “private purchase”.

All medication priced below the prescription charge of currently 5,10 €, has to be paid by the patient and will not be recognised in the calculation of the upper limit. Although Mr. N. can prove that he spent slightly more than 5% of his net income on medication prescribed by his doctors, he still does not reach the upper limit in such a way. If the expenditures under the prescription charge had been recognised, Mr. N. would have saved additional costs of 221 € and would, this year, get his medication for free from September.

He demands, therefore, that all medication listed on the prescription including the so-called private purchase is recognised. The higher need of cheaper medication still causes increased costs, after all.

Since the Minister for Social Affaires announced already in August 2010 his intention to close this gap, the question why nothing has happened so far, is valid.

The Ministry for Health insists, that it still aims at the recognition of all expenditures for medication, nonetheless, it claims that the immediate call for action comes under the jurisdiction of the Main Association of Austrian Social Security Institutions.

In the opinion of the Main Association of Austrian Social Security Institutions, on the other hand, the legislator would be required to act and then also ensure that the additional costs will be covered.

With a view to this stalemate, Ombudsman Kostelka said: “Once more, the patients fall by the wayside in a legal fight between the Ministry of Health and the Social Insurance, since – without prejudice to the justifiable financial line of argument of the health insurance providers – the regulation in force is unfair!”

As then reported in the show, shortly after its recording, Minister of Health, Alois Stöger, made the following comment in the midday radio news programme of Austrian Public Broadcasting: “The existing legal act already puts an obligation on the Main Association of Austrian Social Security Institutions to include cheaper medication in the calculation. Additional funding will not be made available though.” From his point of view, it was important, that not the sick persons had to pay the additional costs, and the Main Association was required to implement the legal commission. He would talk to the Main Association.

Ombudsman Kostelka commenting once more: “It might be feasible to start another negotiation round, but in case it will not lead to success a parliamentary solution before the summer should be the objective. The Ombudsman Board will then join in the efforts and contribute.”

Résumé of the show: so far an open end, apparently however, the requests of people like Mr. N. N. are taken seriously, and the case will be followed-up.