Healthcare policy in turmoil

Following a welcome address by GiG Co-Director Janina Kehr, Barbara Prainsack, a political scientist at the University of Vienna and head of the Centre for the Study of Contemporary Solidarity, explained the difference between a solidarity-based healthcare system and one organised as an insurance scheme: whilst individual insurance premiums are calculated on the basis of risks and expected costs, solidarity-based systems are built around a sense of shared responsibility. Contributions are based on what people can afford, and everyone should receive the support they need from the system.

The problem, according to Prainsack: “At present, many people no longer experience the principle of solidarity.” She called for improvements that go beyond simply focusing on funding: “Reducing redundancies, over-diagnosis and duplicate structures certainly makes sense. However, preventive care saves costs, and it is also ethically important for society to ensure that people are well.”

Dominique Stiefsohn is spokesperson for the Wiener Pflege- und Patient*innen-Anwaltschaft (Vienna Care and Patient Advocacy Organisation). Based on around 9,000 enquiries received each year, her organisation knows that: “Many people cannot cope with the system.” She highlighted in particular the gaps in care within paediatric and adolescent medicine in private practice and in surgical capacity: “Many children fall through the cracks as early as nursery school. Parents have to bear the costs and are reimbursed for only a fraction of them.”

For Richard Gauss, head of the Strategische Gesundheitsversorgung der Stadt Wien (Strategic Healthcare Services of the City of Vienna), solidarity is “the strongest currency we have”. It must be reflected in the structures, but it must also be measurable – for example, in the number of uninsured people who receive treatment, in the neighbourhoods with primary care centres, and in the time doctors have for consultations. Healthcare must not be left to the market, but it does require effective planning: “A public healthcare system based on solidarity and with low barriers to access is a cornerstone of this city.”

Elisabeth Hammer is the managing director of the neunerhaus, a Viennese health centre for people who are homeless, without permanent accommodation or without health insurance. In 2025, 5,317 patients were treated at the neunerhaus; 61 per cent had no health insurance. “All forms of exclusion converge here,” explained Hammer, referring not only to poverty and homelessness but also to language barriers, old age, mental health issues and addiction. And the number of people affected is rising: “There are more and more people who rely on a low-threshold healthcare system that operates as comprehensively as possible.”

Investment in health, therefore – much like investment in education or environmental protection – is not a zero-sum game in which spending in one area necessitates cuts elsewhere. Instead, it saves costs in the long term and generates measurable benefits. Nevertheless, certain political actors are exploiting real problems and public anxiety to stir up sentiment. What is going on here?

Elisabeth Hammer observes a sinister alliance of pressure to cut costs, a shift to the right and few tangible improvements for vulnerable groups. Added to this is the ongoing campaign to undermine solidarity, which does not stop at the health sector: “The shift to the right is permeating the social climate and changing the way administration and bureaucracy operate. We are seeing subtle forms of resistance to benefits: it is becoming more difficult to enforce existing entitlements.” Those affected are being “fobbed off” and accused of having claimed (too) many benefits in the past, in collusion with the NGOs supporting them.

Addressing Richard Gauss, Hammer warned: “Vienna’s healthcare targets cannot be achieved unless we halt the shift to the right in society.”

Dominique Stiefsohn added insights from the middle class: “Many people pay into the system for 30 or 40 years, yet are not treated within a reasonably acceptable timeframe. This is then exploited.” Those who can afford it take out supplementary insurance, “because there’s no other way. The crisis in the healthcare system has reached the middle class.” Stiefsohn spoke of parents who had paid 6,000 euros for their child’s operation: “When they are then reimbursed 255.49 euros by social security, their understanding wanes, as does their sense of belonging to a community.”