21. September 2024

Ombudsman Board criticises health insurance companies: Standardised benefits remain an empty promise

Brothers Karl and Georg B. have Hunter's disease, a metabolic disorder. Both therefore require the same treatment: enzyme replacement therapy, in which the drug Elaprase is administered by infusion. Karl B. is insured with ÖGK. This enables him to have the weekly infusion administered at home by a carer.

His brother Georg B. used to work in the kitchen of a state nursing home, so he is insured with BVAEB. It refuses him home therapy. His mother Marianne B. has to take him 30 kilometres to the hospital each time, and back home again after the five-hour treatment. "I'm at the end of my tether," she said in the ORF programme "Bürgeranwalt".

Ombudsman Bernhard Achitz: "While ÖGK has obviously reached an agreement with the state of Lower Austria on the settlement and cost sharing, BVAEB has not. This is a prime example of the absurdity of the fragmented social insurance system. The often-promised standardisation of benefits is obviously still a long way off."

The BVAEB and the state blame each other for the non-authorisation. "Unfortunately, that often happens. The Austrian Ombudsman Board is calling for the principle of 'pay first, share the costs later' in all cases where health insurance funds and 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 provinces should first provide the service and then work out in the background how to share the costs between them," says Ombudsman Achitz.

Translation was AI-generated