Successes: ÖGK authorises wheelchairs after months and pays for intensive medical care

In October 2023, around ten months ago, he submitted a cost estimate for a new wheelchair and a medical certificate to the ÖGK regional office in Tyrol. In the meantime, he has to use a rental wheelchair that is not adapted to his needs. In order to prevent soreness, his personal assistant currently has to actively change his sitting position several times. With an electric wheelchair adapted to his needs, the 54-year-old would be able to cope with everyday life more independently.

It was only when the Austrian Ombudsman Board became active and filming was already underway for the ORF programme "Bürgeranwalt" with Gerhard R. that the ÖGK relented and approved the wheelchair after all. For Ombudsman Bernhard Achitz, it is completely incomprehensible what took so long to consider: "Mr R.'s clinical picture is known to the ÖGK, he already needed an electric wheelchair. In a case like this, it should be clear that a new wheelchair will be approved quickly and unbureaucratically." This is a mandatory task for ÖGK, and the UN Convention on the Rights of Persons with Disabilities also stipulates that people must have access to the highest quality mobility aids possible in order to lead as independent a life as possible.

Another Tyrolean woman also waited months for funding approval for a wheelchair. Christine A. has multiple sclerosis. She can still get around on foot at home if she can support herself on walls or furniture. However, she would need a wheelchair to get out of the house. Here too, the Tyrolean ÖGK centre only relented after the Ombudsman Board intervened.

Martin Ladstätter, Chairman of BIZEPS, the first Austrian centre for self-determined living, and Vice President of the Austrian Disability Council, emphasises that the people who make such decisions apparently do not realise how much they are affecting the lives of people who are dependent on a wheelchair, for example, but do not receive one. He adds: "It is painful to have to sit in an aid that is not well adapted."

ÖGK is now paying for Gerhard R.'s wheelchair, while the province of Tyrol is paying for the special equipment. Such cost sharing is fine in itself, but the Austrian Ombudsman Board has long been calling for the necessary services to be provided immediately; the organisations involved should agree on how to split the costs. Ladstätter also shares this view: "If the agencies want to negotiate, they are welcome to do so - but please do so in the background and not on the backs of the people affected."

ÖGK authorises 24-hour intensive medical care for Marco J.

The Austrian Ombudsman Board repeatedly criticises such disputes over cost sharing between different actors in the welfare state. For example, in the case of 19-year-old Marco J., who needs artificial respiration and has to be fed via a tube. To prevent him from suffocating, he has to be monitored and cared for around the clock by qualified carers. "It's a clear case that the health insurance fund is responsible for this, there are supreme court judgements on this," says Ombudsman Achitz: "Nevertheless, ÖGK has been dragging its feet for months in this case. Only now, under pressure from the Ombudsman Board, has it finally agreed to take over the financing, together with the Vienna Social Fund (FSW)."

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.