Psychotherapy in Austria- English version

Transcription

1 Psychotherapy in Austria- English version INDEX Psychotherapy in Austria- English version Introduction Expenditure for Psychotherapy Expenses for benefits in kind... 3 a) Cash-financed by psychotherapy associations or institutions... 3 b) Contract and services by doctors under the title "Psychotherapeutic Medicine"... 3 c) Supply and effectiveness of psychotherapeutic medicine... 3 d) Subsidies for Psychotherapy in private practice... 3 e) Own facilities... 4 f) Overall development... 4 g) Expert s opinions Regional distribution Versorgungsvereine (supply institutions)... 5 This is an excerpt of a study on Mental Health in Austria, undertaken by the Main Association of Austrian Social Security Institutions ( Hauptverband der österreichischen Sozilaversicherungsträger ) and the Salzburg Sickness Fund ( Salzburger Gebietskrankenkasse SGKK). The whole study of 2011 can also be downloaded in German: Search Psychische Gesundheit under: Data is based on the calendar year of

2 1. Introduction The aim of psychotherapy is to heal emotional suffering or alleviate, help in life crises, help to change problematic behaviors and attitudes, and to promote the personal development and health. The practice of psychotherapy is regulated by law since 1991 (Psychotherapy Act, BGBl 1990/361). Until that time, only trained doctors had the "license" to engage in the intellectual and spiritual integrity of the patients. Consequently, the medical community has developed its own training tools to "psychotherapy" continue, but to just carry on as "psychotherapeutic medicine" and settle with the insurance institutions. More detailed information on this topic in chapter Ärztliche Hilfe of the study. From 1991, with the 50th Amendment to the General Social Security Act 1956 Psychotherapy is paid (not fully in every case) by the Social Health Insurance. On 31 12th 2009, there were 6,908 therapists (REMARK: approx. 9,000 in 2015) in the corresponding list of the Federal Ministry of Health (BMG) recorded and thus entitled to independent exercise of psychotherapy. This corresponds to a density of 8.3 psychotherapists and psychotherapists per 10,000 populations. Psychotherapy as defined by law is such a vast field that it needs to be delineated, specifying the subject matter for the purposes of social security. Psychotherapy is conveniently interpreted as standardized, teachable and learnable, goal-oriented, theory-based, evidence-based and qualityassured treatment. The definition in the Psychotherapy Act is based on the WHO definition of health and goes far beyond the concept of medical treatment in the General Social Security Act. Consequently, psychotherapists can only be in service for health insurance, as their activity fits into the extent of the obligation and the procedural rules. There is no so called general agreement for psychotherapy, but solid tangible supplies, which have set up the health insurance institutions steadily in recent years. With associations or similar institutions in this regard, contractual arrangements were completed. For all other cases, health insurance has provided subsidies for patients as long as there are no contracts. 2. Expenditure for Psychotherapy Spending on psychotherapy can be different: in benefits in kind, expenses for grants and expenditures for psychotherapy in own facilities of insurance institutions. The expenditure of social security for psychotherapy increased from 29 million Euros in 2001 to 45 million Euros in 2004 and amounted to 54.8 million Euros in In 2009, 62.7 million Euros were spent on psychotherapy (REMARK: More than 70 million Euros 2012, more than 80 million Euros 2015). The largest share of expenditure on the service of supply associations and institutions psychotherapy omitted in kind. Under the title "psychotherapeutic medicine" about 15 million Euros were spent for 2

3 special physicians. Spending on subsidies amounted to about 13 million Euros. Expenditures for Psychotherapy in own facilities amounted to approximately Euros 1 million. The distribution between benefits in kind and subsidies has shifted significantly in recent years towards benefits. The offer has grown different; depending on the insurance institution. The individual institution has a different focus in the supply. The expenditure per eligible patient varies greatly and control mechanisms are also designed differently. 3. Expenses for benefits in kind a) Cash-financed by psychotherapy associations or institutions The cost of health insurance for cash-financed through psychotherapy associations or institutions totaled approximately 34.4 million Euros in 2009 and has since increased steadily. The highest percentage increases in this period have OÖGKK Upper Austria (30.5%) and SGKK Salzburg (36.2%). It should be noted that deductibles for "high earners" (range 5-20 Euros per therapy unit) are established in models in Vorarlberg, Tyrol and Salzburg. b) Contract and services by doctors under the title "Psychotherapeutic Medicine" These services are provided both by (specialist) doctors / physicians with psychotherapy training and of specialists / doctors for psychiatry without this training and from doctors / physicians with the ÖAK Diploma "Psychotherapeutic Medicine" (PSY3). c) Supply and effectiveness of psychotherapeutic medicine Psychotherapeutic medicine is characterized by a fairly low-threshold access. A surprisingly high number of patients (65,500 in 2009, 56,800 in the actual number is probably even higher) is achieved. The duration of the intervention is relatively short and is (on average) 3 to 4 treatments per patient in specialist doctor area - much more at PSY3 doctors. d) Subsidies for Psychotherapy in private practice The subsidies for psychotherapy in private practice are federally regulated and standardized. In order to qualify for a grant to complete, the following requirements must be met: The psychotherapist is registered in the list of BMG Presence of a mental illness Written proof of compulsory medical examination before the second treatment hour The application for the subsidy has to be done usually before the fifth treatment, it is granted for a specific number of hours in a given period. The subsidy amounts to Euros per session (one hour). For a group session (90 minutes), the subsidy is 7.27 Euros. The subsidy scheme was introduced in the absence of an overall contractual agreement with the psychotherapists.. 3

4 In 2009, a total of 12.4 million Euros was spent on grants for psychotherapeutic treatment. Approximately 550,000 units of therapy are co-funded therapy. Current policy line of social security is not to prioritize the subsidy scheme, but the provision of benefits in kind. e) Own facilities The amount of the expenses for the WGKK financed to psychotherapy in their own health centers amounted in 2009 to Euros , euro on those of OÖGKK and those of STGKK to Euros. Total expenses for psychotherapy in those institutions declined by 5.3 percent from f) Overall development In the period between 2007 and 2009, the total expenses for psychotherapeutic services have risen by 9.3 percent. The distribution between benefits in kind and subsidies has shifted significantly towards the benefit in kind scheme. g) Expert s opinions Dealing with the whole theme, stakeholder- and expert interviews were conducted. As expected, psychotherapy as a treatment method was supported by representatives of the field. It is interesting, however, that was stated decidedly by them, that the psychotherapeutic methods in the treatment of severe mental illnesses do not have great strengths, but are suitable as cotherapy to medication. The strengths of psychotherapy were considered in the treatment of mild to moderate disease, especially depression. Again, reference was made to studies showing that psychotherapy in treating mild depression is more effective and less costly than medication. It has been repeatedly criticized, that there is a lack of focus on the treatment of severe ill patients. And, especially in terms of a possible deterioration of a minor mental situation, psychotherapy should be granted at an early stage of the disease - especially here brief interventions have good results. On doctor s side, criticism of psychotherapy is rife. It ranges from flawed diagnosis of mental illness to the accusation that intervention priorities relate to very slight disturbances even below the disease threshold. In addition, "hidden" faults would sometimes not be recognized by psychotherapists, and thus the situation of the persons concerned could deteriorate nevertheless, psychotherapy is considered especially as co-therapy to medication in severe cases as appropriate. However, a stringent treatment plan seems to be necessary. 4

5 4. Regional distribution A problem of psychotherapeutic care is the regional inequality of the offer, between regions as well as between town and countryside. In 1996, 70 percent of the eligible professional people were established in the cities and in the city-suburban districts (ÖBIG 1997). In contrast, the rural areas were largely underserved: there is a relatively low supply in Upper Austria, Lower Austria, Carinthia, Styria and Burgenland. The regional inequality of psychotherapists between the regions is almost unchanged since The differences are very pronounced: Vienna, currently psychotherapists per 10,000 populations, the highest power density, the Burgenland the least. Again, these differences have remained essentially unchanged since A similar situation is apparent from viewing the differences between city and country from the patient s side. Psychotherapy has traditionally been a rather urban phenomenon because barriers such as lack of information and lack of social control are more pronounced. This situation is unchanged upright till now: Although the number of psychotherapists raised slightly more in rural areas than in urban areas and therefore the comparison of the years shows a continuous increase of the offer in rural areas, the majority of psychotherapists are still concentrated in the capitals. 5. Versorgungsvereine (supply institutions) They are now available in all regions except Vorarlberg and Carinthia. In Carinthia, the offer of institutions (clinics) is provided, in Vorarlberg VGKK gives a certain amount of funds to finance psychotherapy together with the regions government, which in turn uses an institution. 2009, there were 11 (large) psychotherapeutic care associations... In Austria in the year psychotherapists took part within these institutions. A number that corresponds to a share of about one third of the currently licensed professional psychotherapists. How many hours are provided under the kind-care scheme? In 2009, about 500,000 units of psychotherapy were provided. Group and family settings together accounted for a share of only around 4%. In addition there are some highly specialized institutions and numerous contracts (including smallest facilities with 50 treatment units / year). These additional psychotherapeutic services provide (according GÖG / ÖBIG 2009 Sources) an estimated 70,000 Psychotherapy units in total - Example Upper Austria: 4 and refugee assistance center, about 8,000 units; Carinthia: the larger institutions have done a total of about 20,000 units of psychotherapy. How many patients got treatment? More than 31,000 patients in 2009; added the larger institutions in Carinthia and Vorarlberg, at least 2,000 more patients could be treated (REMARK: this number now increased up to 55,000 in the year 2015). 5

6 According GÖG / ÖBIG sources at least another 2,500 other people were supervised by the small institutions. Is it possible to create an overview of treatment durations? Only a quotation is available between 10 and 30. What about patients that got subsidies? Roughly the same number of patients as within the kind care scheme could be reached. Overview of Institutions: Province Seat Name, number of therapists (2009) B Eisenstadt Institute for Psychotherapy in rural areas (IPR) 44 NÖ Wien Lower Austrian Society for psychotherapeutic Care (NÖGPV) 130 NÖ Wien Association for outpatient psychotherapy (VAP) 53 OÖ Linz Association for prophylactic health work (PGA); 105 therapists - Note: these therapists are employed by the PGA OÖ Linz Upper Austrian Society for Psychotherapy (OÖGP); 175 S Salzburg ARGE Salzburg Psychotherapy, 264 (275 in early 2011) St Graz Styrian Network for Psychotherapy; 180 therapists St Graz Association for outpatient psychological psychotherapy; 45 T Innsbruck Society for psychotherapeutic care intyrol (PVT), range W Wien Viennese society for psychotherapeutic care (WGPV); 552 W Wien Association for outpatient psychotherapy (VAP); 170 therapists 6