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Cross-Border Mobility in Health Care
– An Economic Analysis of the Nature and Consequences
of Health Migration in Europe
Study: Ao. Univ.-Prof. Dr. August
Österle
Mag. Maureen Lenhart, Mag. José Delgado (Wirtschaftsuniversität
Wien)
Project 2007-2008 funded by Jubilaeumsfonds
der OeNB.
The project undertakes an economic analysis of the nature
and the consequences of cross-border mobility in health
care. The in-depth analysis focuses on two case studies,
the analysis of dental care tourism between Austria
and Hungary and the analysis of nurse migration from
Central-Eastern European countries to Austria. The research
builds on a literature review and an examination of
the legal and institutional context for cross-border
mobility. The empirical analysis of the two case studies
uses discrete choice analysis. Finally, the results
will be discussed with regard to perspectives and implications
of health care mobility in Europe.
www.wu-wien.ac.at/healthmobility
Dental Care Migration in Central
Europe
Dissertation:
Mag. José Delgado (Wirtschaftsuniversität
Wien / Abteilung für Wirtschafts- und Sozialpolitik
/ Betreuer: Prof. Dr. August Österle)
The mobility of patients became a
prominent issue in European health policies in recent
years. European Court of Justice decisions, at first
in the cases of Kohll and Decker, have opened up new
opportunities for cross border care. In the border region
of Austria and Hungary, patient migration for dental
care is of particular importance. An exploratory study
shows that cost considerations are of key importance
to patients, while experts point at quality risks involved.
In general, dental care migration has reached considerable
levels with a potential of further increase. However,
this will depend on the developments in an increasingly
competitive situation in Hungary, on the reactions by
the dental care sector in Austria, developments on the
European level, and in particular on how quality can
be successfully assured when travelling abroad for health
treatments.
For further
reading see the healthregio-Report (p. 130-135)
Migration of Nurses
Dissertation: Mag. Maureen
Lenhart (Wirtschaftsuniversität Wien, Institut
für Sozialpolitik / Betreuer: ao.Univ.Prof. Dr.
August Österle)
Nurse
migration became a well known subject because of shortages
of nurses in several European countries. Austria is
no exception of this development on the health labor
market. The discussion of a possible shortage however
is not a new one. Since 1967 Austria has been a main
destination country for nurses from all over the world
and was characterized by being mainly a target of migration
from South East Asia, namely from the Philippines. Today
the main source countries are Central-East and South-East
European countries. The research will focus on this
phenomenon and its impact on Austria. It will discuss
the main developments of the past, of today and what
will happen in future.
Leistungen bei Pflegebedürftigkeit
im Lichte des koordinierenden europäischen Sozialrechts
Dissertation: Mag. Nina Hickmann
(Rechtswissenschaftliche Fakultät der Universität
Salzburg, Betreuer: Prof.Dr. Walter Pfeil)
Um soziale Nachteile für WanderarbeitnehmerInnen
und sonstige Erwerbstätige zu verhindern und die
Mobilität von ArbeitnehmerInnen zu gewährleisten,
wurden von der EU Koordinierungsvorschriften erlassen.
Ziele dieser Vorschriften sind u.a. Diskriminierungsfreiheit,
Zusammenrechnung der Versicherungszeiten, Leistungsexport.
Die wichtigste sekundarrechtliche Bestimmung für
die bisherigen Entscheidungen des EuGH ist die VO 1408/71
über die Anwendung der Systeme der sozialen Sicherheit
auf Arbeitnehmer und Selbständige sowie deren Familienangehörigen,
die innerhalb der Gemeinschaft zu- und abwandern, die
nunmehr durch die VO 883/04 abgelöst wird, sowie
die VO 574/22 zur Durchführung der Verordnung 1408/71.
Die vorliegende wissenschaftliche Arbeit konzentriert
sich auf die Erfassung von Leistungen bei Pflegebedürftigkeit,
wobei nach einer gesellschaftspolitischen und ökonomischen
Betrachtung, eine problemorientierte Darstellung der
Rechtslage in Österreich erfolgt.
Daran schließt sich eine Analyse der einschlägigen
Regelungen des europäischen koordinierenden Sozialrechts,
die dann in einer intensiven Auseinandersetzung mit
der VO 883/04 gipfelt.
Die Exportportpflicht von Geldleistungen bei Pflegebedürftigkeit
dürfte nach einigen EuGH-Entscheidung eindeutig
geklärt sein. Zum Verhältnis von solchen,
aus anderen Mitgliedstaaten bezogenen Pflegegeldern
zu (den am jeweiligen Wohnort) in Anspruch genommenen
Pflegleistungen in natura gibt es bisher kaum befriedigende
Ansätze - daher wird diese Problematik der Kern
der Auseinandersetzung sein.
Lack of nursing stuff and labour
law
Diplomarbeit: „Arbeitsrechtliche
Probleme der Pflege zu Hause“
Mag. Nina Hickmann (Universität Salzburg / Rechtswissenschaftliche Fakultät
/ Betreuer: Dr. Walter J. Pfeil)
The obsolescence of
people and the increase of illnesses such as dementia and Alzheimer are leading
to a notable increase of the need for care especially in the field of home care.
A detailed discussion about the problems of home care in terms of employment
law is urgently needed. |
Wissenschaftspreis der AK OÖ
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Only a very small percentage of professional
Austrian nursing staff is working in the field of home
care. Many patients
are already being looked after by foreign nursing staff.
The form of employment is mostly not regulated and therefore
situated in a legal twilight zone. Legal employment (placement
of nursing staff by a social agency, employment of staff
by the patient) which secures basic protection by law,
collective contract and minimum wages is very rare.
In the common case of a “14 day - 24 hour a day” care
by foreign nursing staff, common legal basises such as
employment contracts, freelance agreements or contracts
of work and labour with all the necessary payment agreements
and regulations of working hours do not apply. There is
also no insurance in case of sickness or any regulations
of liabilities. By avoiding proper legal employment very
often social fraud is proofed as a matter of fact according
to §153c of the criminal code.
The current situation is silently tolerated by politics.
It covers an ovbious gap within the Austrian system, the
authorities save money because most of the services are
being paid for by the patients themselves. Apart from the
problem of exploitive employment the community looses huge
amounts of taxes and social security contributions. Apart
from this, legal providers of the services are put under
enormous cost pressure: the dumping of wages, the loss
of prestige for nursing jobs and the undermining of employment
law standards are resulting from this situation. Experts
also say that currently supported models such as the service
cheque are not the adaquate means to reduce illegal employment
of foreigners in Austria. Only forseeing and long term
strategies – like an adjustment of employment law
or the improvement of the conditions of care by family
members - will be able to secure an improvement of the
situation. Especially the development of innovative models
for living and care could guarantee advancement.
For further reading see the healthregio-Report (p. 136-141)
The spa, rehabilitation and wellness sector in Austria's
eastern border region
Diplomarbeit: „ Kur, Rehabilitation und Wellness
im östlichen Grenzraum Österreichs"
Mag. Beatrix Kohlbauer (IMC Fachhochschule Krems / Studiengang
Gesundheitsmanagement / Betreuer: Dr. Tom Schmid, Sozialökonomische
Forschungsstelle Wien)
The eastern enlargement of EU results
in economic and structural changes in the health sector
of the Austrian, Czech, Hungarian
and Slovak border region that have an impact on the services
offered as well as on the labour market situation and tourism
development. This also affects service providers, consumers
and employees in the spa and wellness sector. Health tourism
is a significant economic factor in the Central European
region — this phase of radical change offers unique
opportunities to re-position this region as a location
for business and high-quality health tourism.
In the future, it will be even more important that the
providers of such services recognise trends at an early
stage and position themselves on the market by providing
services responding to existing demand: in particular,
high quality standards become more and more important.
To meet rising customer needs and high quality requirements,
innovative concepts and co-operation are necessary.
Upon the accession of the neighbouring countries to the
EU, competition has intensified especially in those economic
sectors in which low wages play a decisive role as a comparative
locational advantage. It is to be expected that sites with
competitive rather than comparative locational advantages
will be more successful in the future and stable in the
long term. Adaptability, ability to co-operate and innovatory
potential will be the main decisive success factors for
enterprises.
For further reading see the healthregio-Report
(p. 142-146)
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