After several months in hospital, Marko J. was due to be discharged from hospital in autumn 2022. The Favoriten clinic prescribed all-day intensive care at home. However, ÖGK did not seem to want to deal with this any further and returned the prescription without comment.
The Supreme Court has ruled that intensive care for patients requiring mechanical ventilation is medical treatment
Strictly speaking, ÖGK should provide 24-hour intensive care as a benefit in kind, i.e. send suitable carers. However, as it does not have a contractual partner for this, there is a financial subsidy according to the statutes. "However, the hourly rate is nowhere near enough to cover the costs of one hour of care," says Achitz: "Instead of paying out support for at least 24 hours, ÖGK has now offered ten hours following the intervention of the Ombudsman Board. I don't understand why the families concerned are being haggled with like at a flea market, because the Supreme Court has clearly ruled that intensive care for people requiring mechanical ventilation is to be regarded as medical treatment and that the health insurance fund must therefore pay."
Marko J. was discharged from hospital in February 2023 - but only because the Vienna Social Fund (FSW) agreed to temporarily cover all of the costs, for which the ÖGK is actually responsible. However, Marko J. and his father were asked to demand an actionable decision from the ÖGK and to go to court.
The Austrian Ombudsman Board is calling for the principle of "pay first, share the costs later" to be applied in all cases where health insurance funds and the provinces disagree on who is responsible. The people affected and their families should not have to deal with endless bureaucratic procedures. The health insurance funds and the federal states should first provide the service and then work out in the background how to divide the costs between them," says Ombudsman Achitz.
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