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The progressively ageing society and new medical technologies are challenging the Austrian health and legal system. Laws must be amended or rewritten. Medical law expert Karl Stöger from the Institute of Public Law and Political Science at the University of Graz is examining how new medical technologies are compatible with legal requirements. In this interview he sheds light on the current discourse in Austria.

Rising life expectancy and the provision of medical care for the elderly are major challenges for the healthcare system. New medical technologies such as robots could take over part of this care. However, this will result in conflicts with current legislation. Particularly where data protection and liability are concerned.

New medical technologies based on artificial intelligence are far more likely to replace doctors than medical devices. The boundaries between humankind and machines are blurring. Consequently, the question has arisen as to whether artificial intelligence should be regulated. And should that be done in the same way as a device or as a human being?

Nonetheless, at the same time, the healthcare system has problems properly fulfilling the needs of patients. Part of the population are able to afford better treatment through supplementary insurance and special outpatient clinics. Stöger sees this as posing a danger to healthcare across the class divide. That’s why he is trying to find legal solutions for adequate basic medical care.

Karl Stöger in an interview with Innovation Origins:

What challenges do advancing technology pose for the Austrian health and legal system?

One topical issue that is currently high on the agenda is medication. The technological advancements in medicine mean that we have a greater quantity of better and more effective medications. But these are also more expensive and as a result are no longer affordable for everyone. This raises the question as to what level of treatment the healthcare system should provide each patient. Another problem is that some pharmaceutical companies do not supply Austria with medications at all as the market is relatively small and the quantities are minimal.

Another issue currently under discussion is telemedicine. This means that physicians and patients no longer have to be in the same place as each other. Even bedridden elderly patients and patients in remote areas can receive better medical care when a doctor is able to advise them by telephone. However, this is not yet deductible under welfare legislation. The problem is not insurmountable. But the question remains as to how we go about it.

Artificial intelligence can provide decision-making systems for doctors. AI diagnoses already outperform doctors where diagnostic imaging equipment is concerned. AI learns from an existing database. The big issue here is data protection. The question of how to deal with this facet is once more brought to the fore. It is also important to let patients know that data may be used anonymously so that other patients can be helped. Except, the better the system, the greater the possibility that the system will be able to identify the individual patient. For instance, if she or he has a particular type of tumor. We have to overcome the challenge of data accessibility. But the legal system still needs to catch up. At the same time, this issue should also be resolved at a European level.

neue medizinsiche Technologien, rechtliche Vorschriften
Univ. Prof. Dr. Karl Stöger, MJur (c) University of Graz

If systems were to work autonomously, the question of who is responsible also comes up.  One suggestion is that autonomous entities could be created. The intelligent machine would then be responsible. It has always been the case that when I travel with an item, I am legally required to have it under control.  This is done via compulsory liability insurance. The question now arises as to whether autonomous systems should also be treated like this.

But who is to blame if mistakes happen in hospitals? Who do I hold responsible? If it is a manufacturing fault, I can hold the manufacturer responsible. But the manufacturer can’t help it if someone has trained the system using faulty data. This is a challenge that applies to the entire digitization process.

In a project that we (as in the University of Graz) carried out together with Joanneum Research and Med Uni Graz, it was all about equipment for measuring blood glucose and insulin dosages for diabetes. The system can be run on a tablet and is already in use in some Austrian hospitals. The question was whether the system could also be used in home care. If the system works correctly, the nurse assistant only has to read the data and inject insulin. At present, however, this is not legally possible because the read-out data must be checked by qualified nursing staff. This means that we are still coming up against legal limitations. We need to change the law – and it is not that simple.

In what ways could digitization support a fairer healthcare system?

Wearables such as health monitors or apps provide ever better ways of compiling data. Doctors could use this data to treat their patients more effectively. In Austria, however, the use of genetic analyses is only possible on a limited basis. This is because there is a risk that private insurance companies could have access to information on the health status of individuals. As a result, individuals with a high health risk could be rejected by private insurers.  Plus the concept of a statistics-based high-risk community would be lost. Yet can people be held responsible for the fact that cancer, for example, is prevalent in their family? There is also the danger that people with a certain risk profile will become exclusively dependent on state health insurance.  High costs could be incurred there that way.

Which legal provisions would contribute to an affordable healthcare system?

The Austrian health system is financed by the federal government and the states. The Austrian Federal Government is responsible for the social welfare system and registered physicians. The states take care of hospitals. These provisions are laid down in constitutional law. The problem is that this regulation in some cases is ambiguous and expensive as a result of the doubling up of work. Savings can be achieved by consolidating services. Treatments should be concentrated at specific locations so that equipment and specialists are utilized as efficiently as possible. Hospitals have to close and merge for this purpose. However, patients think that care will be worse if the hospital around the corner shuts down. Planning and provision of care have to be carefully thought through.

One such case currently pending before the Constitutional Court is a new planning system has been in place for a year now. It spans both the federal and state levels. However, it is not clear whether this system is legally valid as the Constitution has not yet been amended.

Moreover, costs in the hospital sector and for general practitioners should also be limited. But without a deterioration in patient care, of course. In private practices, for example, savings may be made on medicines. A reimbursement code defines which medicines health insurance pays for. Some brand name drugs are not reimbursed because the same active ingredient is available in a generic drug. This is also controversial.

Thank you for this interview.

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