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

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

On 21 and 22 May 2026, experts from academia, medical practice, health economics, public administration and the life-sciences sector met at the JKU MED Campus Linz to discuss how health systems in Austria, Germany and Switzerland can remain capable of delivering high-quality care under demographic, financial and organisational pressure.

The symposium examined a common problem from several angles: populations are ageing, chronic and age-related diseases are becoming more important, health and long-term care systems face persistent labour shortages, patients move through increasingly complex care pathways, and medical innovation creates both major welfare gains and difficult financing questions.

A central conclusion was that future health policy cannot be reduced to “more money” or “more services”. Sustainable reform also requires clearer priorities, stronger primary care, better data on patient pathways, digitally supported coordination, fair and attractive working conditions, evidence-based decisions on reimbursement and a financing model that makes the trade-offs between access, quality, efficiency and solidarity explicit.

Main points

Demographic change is the starting point for almost every reform question. Ageing societies will increase demand for medical treatment, long-term care, dementia care, cardiovascular care and multimorbidity management. The challenge is not only epidemiological; it also affects labour markets, public finances, family care, productivity and intergenerational fairness.

Innovation is necessary, but it must be governed. New therapies, diagnostics and digital tools can improve quality of life and keep people active in work and society. At the same time, high-cost innovations—especially where large patient groups are eligible—can create severe budget effects and force implicit rationing unless transparent evaluation and prioritisation mechanisms are in place.

Workforce shortages are a structural constraint. Several contributions showed that health systems cannot simply expand activity volumes indefinitely. The policy response must combine better wages and working conditions, smarter task allocation, interprofessional teams, digital support, more attractive care professions and realistic planning of training capacity.

Patient steering emerged as a key reform lever. Systems with free and repeated access to many providers risk overuse, duplication and weak continuity. Gatekeeping, primary-care registration, digital triage, co-payment design and patient-sharing network analysis can help direct patients to the right level of care—provided that primary care has enough capacity and authority to coordinate.

Financing and governance must become more explicit. Several speakers highlighted that public health systems operate with finite resources while legal and political expectations often imply unlimited entitlement. Reform therefore needs clearer decisions on what is funded, how benefits are assessed, which level of government is responsible, and how regional flexibility can coexist with national standards.

Overview of the sessions and section leads

Scientific leadership: Prof. Gerald Pruckner

The symposium was scientifically led by Prof. Gerald Pruckner at JKU Linz. Its structure brought together health economics, medicine, public finance and health-system governance in order to connect disease-specific evidence with broader institutional reform questions.

Session 1: Demography and health

This session focused on how ageing changes disease burdens, care needs and macroeconomic conditions. Dr. Kai Loewenbrück discussed dementia and neurodegenerative disease as a central health-economic challenge: dementia prevalence is expected to rise sharply, new Alzheimer therapies may slow disease progression, but their cost-effectiveness and budget impact raise difficult questions about access, prioritisation and fairness.

Further contributions placed the issue in a wider demographic frame. Prof. Friedrich Breyer addressed sustainable financing of long-term care insurance in Germany. Prof. Klaus Prettner analysed the macroeconomic effects of demographic development. Prof. Martin Halla examined social inequality in mortality, while JKU-linked clinical perspectives, including cardiovascular epidemiology, connected demographic change to concrete disease patterns and service needs.

The overarching message of Session 1 was that demographic change is not an isolated medical issue. It changes the composition of demand, increases the need for long-term and coordinated care, and forces policy-makers to decide how scarce resources should be allocated when both disease burden and technological possibilities expand.

Session 2: Health and the labour market

Prof. Iris Kesternich led the discussion on labour shortages in the German care sector. Her contribution summarised evidence on collective wage agreements, future care costs and the question of whether additional insurance protection is needed. The core insight was that higher pay and better employment conditions can improve the attractiveness of care work without automatically causing employment losses, but financing and institutional design matter.

The session also considered the Swiss perspective through Dr. Christian Schmid and the reciprocal relationship between health shocks and labour-market participation through Prof. Wolfgang Frimmel. Together, these talks showed that health systems are also labour-market institutions: they depend on enough qualified workers, while health shocks and access to care influence whether people can remain economically active.

The main policy implication was that workforce strategy must be part of health-system strategy. Training, retention, professional roles, working conditions, digital assistance and financing rules determine whether additional demand can actually be met.

Session 3: Patient steering

Prof. Leonie Sundmacher led the discussion on patient steering in the ambulatory sector in Germany. Her contribution emphasised that Germany has a broad supply of providers, but insufficient coordination of patient pathways. Routine data, sequence analysis, continuity indices and patient-sharing networks can identify where care is fragmented and where stronger primary-care coordination improves outcomes.

Prof. Martin Salm complemented this with the question of co-financing models and whether financial participation can steer patient flows. The session compared instruments such as provider-choice restrictions, gatekeeping, benefit design, financial incentives for insured persons and remuneration incentives for providers.

The session’s central point was that steering should not be understood as a blunt restriction of access. It can improve care if it gives patients clearer orientation, reduces unnecessary contacts and duplicate diagnostics, strengthens continuity and gives primary care the resources to coordinate complex cases.

Session 4: Costs, benefits and medical innovation

Alexander Mülhaupt of Roche Austria led the innovation perspective by arguing that medical progress creates value for patients, society and the economy. Innovative therapies can preserve quality of life, reduce disability, support labour-market participation and strengthen the life-science location. However, innovation requires long development cycles, high investment and a policy environment that treats health not only as expenditure but also as an investment in future welfare.

Christoph Badelt, President of the Austrian Fiscal Advisory Council, addressed public finances and health-system financing. Jakob Hochgerner from the Health Department of Upper Austria focused on subsidiarity and central steering in health care. His contribution highlighted the complexity of the Austrian system, the consequences of very high contact rates, the lack of binding utilisation rules and the need for central decisions on workforce, planning, financing, access rules and benefit entitlements.

The session linked innovation, fiscal sustainability and governance. Its main message was that health systems must create room for valuable innovation while also avoiding uncoordinated spending growth. This requires transparent evaluation, clearer responsibilities and reforms that align medical benefit, affordability and system capacity.

Final panel discussion

The final panel brought together Christoph Badelt, Alexander Mülhaupt, Elgin Drda, Matthias Bolz and Jakob Hochgerner, moderated by Sigrid Brandstätter. The discussion connected the symposium’s themes: demographic pressure, public budgets, the value of innovation, regional implementation, medical education and the practical organisation of care.

Across the panel, the recurring question was how the DACH region can move from problem diagnosis to implementable reform. The answer suggested by the symposium is a combination of evidence-based priority setting, stronger primary care and patient pathways, realistic financing, better use of health data, fair workforce policies and institutional willingness to make trade-offs explicit rather than leaving them hidden in waiting times, unequal access or local bottlenecks.

Conclusion

Health care in societal transformation is therefore a governance challenge. The DACH region has high-quality medical capabilities and strong institutions, but the pressures of ageing, workforce scarcity, fiscal limits and technological change require more deliberate system design. The symposium showed that better outcomes depend on coordinating medical innovation, financing, workforce policy and patient pathways into a coherent reform agenda.