OBJECTIVES:
Prolonged waiting times for magnetic resonance imaging (MRI) pose risks to patient safety and quality of care, while faster access for self-paying patients raise concerns from an equity perspective. Although maximum MRI waiting time targets were introduced in Austria in 2018, it remains unclear whether these targets are met in practice. This study aims to assess MRI waiting times across Austria and identify disparities between statutory coverage and self-paying patients.

METHODS:
In March-April 2025, we conducted a nationwide field study using standardized simulated-patient phone calls to all Austrian MRI providers contracted with social health insurance (SHI) that accept outpatient referrals (n=90). The next available MRI appointment was requested for two scenarios: anterior cruciate ligament (ACL) rupture (case 1) and suspected hemochromatosis (case 2). Providers were additionally asked whether self-pay would shorten waiting times and at what price. Where available, waiting times were also obtained via online booking. Median waiting times (working days) were compared using Wilcoxon signed-rank and Kruskal-Wallis tests.

RESULTS:
Under statutory coverage assessed via phone booking, median waiting times were 15.0 days for case 1 and 37.5 days for case 2. Overall, 60% of providers met the 20-day target in case 1 and 11% in case 2. Online booking data showed medians of 11.0 days for case 1 and 39.0 days for case 2. In 12.5% and 13.4% of calls, providers indicated that self-pay would shorten waiting times, reducing the wait to 1 day for case 1 and 2 days for case 2, at mean costs of EUR 315 (case 1) and EUR 361 (case 2), respectively. Waiting times varied between and within federal states.

DISCUSSION:
Austria’s MRI waiting-time guarantee was often not met, with significantly lower compliance for suspected hemochromatosis. While not routinely offered, self-pay enabled rapid access, suggesting the persistence of a residual two-tier mechanism.