Health Care in Societal Transformation – A View of the DACH Region

Health Care in Societal Transformation – A View of the DACH Region

At a glance

Experts from academia, medicine, public administration, and industry met in Linz to discuss how Austria, Germany, and Switzerland can maintain high-quality health care as populations age and health systems face tighter budgets and staff shortages. A recurring message was that more money or more services alone will not resolve these pressures. Sustainable reform also requires clear priorities and stronger primary care. It needs better coordination and transparent decisions about how limited resources should be allocated.

Five key takeaways

1. Ageing is the starting point for almost every reform question. Demand for medical treatment and long-term care will rise, putting pressure on public finances, labour markets, and families.
2. Medical innovation creates value, but it must be carefully assessed. New therapies, diagnostics, and digital tools can improve quality of life. However, high-cost treatments, particularly those for large patient groups, can strain budgets or force implicit rationing unless their benefits and costs are evaluated transparently.
3. Staff shortages constrain what health systems can deliver. Meeting growing demand requires better pay and working conditions, smarter task allocation, and stronger teamwork between professions. Digital support and realistic planning of training capacity also matter.
4. Better patient steering can improve coordination and continuity of care. Approaches such as gatekeeping, primary-care registration, and digital triage can help patients reach the appropriate level of care. Co-payment design can also play a role. Success depends on primary care having enough capacity and authority to coordinate treatment.
5. Financing and governance need clearer priorities. Public resources are finite, so reform requires explicit decisions about which services are funded, how benefits are assessed, and who is responsible. Regional flexibility must also be reconciled with national standards.

What we discussed

Session 1: Demography and health

This session examined how ageing changes disease patterns, care needs, and the wider economy.

Dr. Kai Loewenbrück discussed dementia and neurodegenerative diseases as a major health-economic challenge. Dementia prevalence is expected to rise significantly. New Alzheimer therapies may slow disease progression, but questions about cost-effectiveness and budget impact raise difficult issues concerning access, prioritisation, and fairness.

Prof. Friedrich Breyer addressed the sustainable financing of long-term care insurance in Germany. Prof. Klaus Prettner examined the macroeconomic effects of demographic change, while Prof. Martin Halla considered social inequality in mortality. Clinical perspectives linked to JKU, including cardiovascular epidemiology, connected demographic change to specific disease patterns and health-care needs.

Key takeaway: Demographic change is not solely a medical issue. It affects the type and volume of care required and increases the need for long-term and coordinated services. It also forces policy-makers to consider how limited resources should be allocated as both disease burdens and treatment possibilities expand.

Session 2: Health and the labour market

This session explored labour shortages in the care sector and the relationship between health and employment.

Prof. Iris Kesternich examined labour shortages in Germany's care sector, including collective wage agreements, future care costs, and the question of whether additional insurance protection is needed. Her contribution highlighted that higher wages and better employment conditions can make care work more attractive without necessarily reducing employment, although financing and institutional design remain important.

Dr. Christian Schmid provided the Swiss perspective. Prof. Wolfgang Frimmel examined the two-way relationship between health shocks and participation in the labour market.

Together, these contributions showed that health systems depend on enough qualified workers. At the same time, people's health and access to treatment can affect their ability to remain economically active.

Key takeaway: Workforce planning must be an integral part of health-system reform. Training, staff retention, and working conditions all influence whether growing demand for care can be met. So do professional roles, digital assistance, and financing rules.

Session 3: Patient steering

This session focused on how patients can be guided towards the appropriate level of care, particularly in Germany's ambulatory sector.

Prof. Leonie Sundmacher examined the coordination of patient pathways. Germany has a broad range of health-care providers, but patient pathways can lack continuity and coordination. Routine data can reveal fragmented care. Treatment-sequence analyses, continuity indices, and patient-sharing networks show where stronger primary-care coordination may improve outcomes.

Prof. Martin Salm considered co-financing models and whether patients' financial contributions can influence how they use health services.

The session explored several approaches. These included restrictions on provider choice, gatekeeping, and benefit design, as well as financial incentives for patients and payment incentives for providers.

Key takeaway: Patient steering need not mean simply restricting access to care. When appropriately designed, it can help patients navigate the system and reduce unnecessary appointments and duplicate tests. It can also improve continuity and strengthen primary care's ability to coordinate complex cases. These benefits depend on adequate primary-care capacity and resources.

Session 4: Costs, benefits, and medical innovation

This session connected medical innovation with public finances and the governance of health systems.

Alexander Mülhaupt of Roche Austria discussed the value of medical progress for patients, society, and the economy. Innovative therapies can preserve quality of life and reduce disability. They can also support labour-market participation and strengthen the life-sciences sector. However, innovation requires long development cycles and high investment. It also needs a policy environment that treats health expenditure not only as a cost but also as an investment in future welfare.

Christoph Badelt, President of the Austrian Fiscal Advisory Council, addressed health-system financing from the perspective of public finances.

Jakob Hochgerner of the Health Department of Upper Austria examined subsidiarity and central steering in health care. His contribution highlighted the complexity of the Austrian system and the implications of high contact rates. He also pointed to the absence of binding rules on utilisation. He called for clearer central decisions on workforce planning and financing, and on access rules and benefit entitlements.

The discussion connected the potential benefits of medical innovation with the need for financially sustainable health systems. Transparent evaluation and clearer responsibilities were identified as important elements of reform.

Key takeaway: Health systems need to make room for valuable medical innovation while managing spending growth. This requires assessing the benefits and affordability of new treatments, clarifying institutional responsibilities, and aligning medical progress with the resources and capacity available.

Final panel discussion

The final panel brought together Christoph Badelt, Alexander Mülhaupt, Elgin Drda, Matthias Bolz, and Jakob Hochgerner, with Sigrid Brandstätter as moderator.

The discussion brought together the symposium's central themes. These included demographic pressures, public budgets, and the value of medical innovation. Regional implementation, medical education, and the practical organisation of care also featured.

A recurring question was how Austria, Germany, and Switzerland can move from identifying problems to implementing effective reforms. The discussion pointed to the importance of evidence-based priorities, stronger primary care, and better-coordinated patient pathways. Realistic financing, better use of health data, and fair workforce policies were also important themes.

Key takeaway: Reform requires health systems to address competing priorities openly. If trade-offs are not made explicit, pressures may instead emerge through waiting times, unequal access, or local bottlenecks.

Conclusion

Health care in societal transformation is fundamentally a governance challenge. Austria, Germany, and Switzerland have high-quality medical capabilities and strong institutions, but demographic change and workforce shortages place increasing demands on their systems. So do fiscal constraints and technological progress.

The symposium highlighted the need to address these pressures together rather than in isolation. Better outcomes depend on coordinating innovation, financing, and workforce policy with patient pathways within a coherent approach to health-system reform.