in 2010 under the chancellorship of werner faymann, the social democratic health minister alois stöger began the process of reform as a response to rising healthcare costs and difficulties with capacity. the system is financed in part with public debt which had become a significant challenge in the aftermath of the recession which hit austria in 2009. the reforms for 2013 aimed to increase capacity, improve the quality of care, and address fiscal concerns in concert with the finance ministry. a key outcome of the reform with the introduction of a budget cap on healthcare expenditure. the idea of structural reform was not entertained. because of the federal structure of austria the legal structure of the social security programme is unusually complex with multiple entities at the state level under the umbrella of the national institution: making adjustments to the federal framework would present a constitutional issue.