Organisation and structure of the system in Austria

Sources of funding


In 2003, the calculation method used by Statistics Austria (ESA 95—“European System of Accounts”) indicated total spending of ca. EUR 17 billion for the Austrian health care system. The proportion of the gross domestic product was thus 7.5 percent, of which 67.1percent is attributable to public health expenditures (Source: Statistics Austria). In comparison with other countries, Austria occupies an average position. Since the beginning of 2005, step-by-step implementation of the “System of Health Accounts” for the calculation of health expenditures has been taking place in Austria. Initial results from these calculations, which complement those of the ESVG 95, have been available since the end of 2005. (Gaugg 2005 p. 110)


Over the past 20 years, a significant shift of the financing load to private households can be observed; the most important forms of private health-related spending are deductibles, additional fees and co-payments, which currently amount to 28 percent of health-related spending. The total income of the social health insurers was EUR 11.2 billion in 2004. The rise in income as a percentage of the previous year’s figure was 2.8 percent, that of spending 3.9 percent. In order to raise cost-consciousness, the social health insurers have been required since 2003 to inform insured parties once a year about the costs of the services provided for them and their dependents. (Gaugg 2005 p. 108-109)

As is shown in the table below, health insurance is primarily funded by contributions, which are raised half by employees and half by employers in the case of those persons who are not self-employed. At present (2005) the rates of contribution to health insurance, which vary depending on the type of employment, are 7.5 percent for white-collar and blue-collar workers and 7.3 percent for civil servants. The monthly top threshold in the health insurance is currently at EUR 3,630 per month. The rate for self-employed persons stands at 9.1 percent, and 7.5 percent applies to farmers, with the highest contribution base being EUR 4,235 in each case. (Gaugg 2005 p. 109)



The social security system

The system of social security in Austria is a public welfare system including legal measures to ensure a basic standard of living and provide health services in the following cases:IllnessInvalidityMaternityUnemploymentOld ageDeath of a person obligated to pay financial support

Furthermore, the Austrian social security system provides support for the permanently handicapped,and since 1993 it has paid money to people requiring permanent care and in need of help (nursing benfits—“Pflegegeld”). The amount of these payments depends on the degree of the handicap or the extent of the nursing needs. The Austrian social insurance comprises the branches of health insurance, accident insurance and pension insurance. The implementation of social insurance is ensured by separate corporate bodies—the so-called social insurance institutions. Currently there are 17 health boards and seven insurance institutions, of which some cover two or all three fields of social insurance. The structure, both by region and by professional groups, has evolved historically. All insurance carriers are combined in the Main Association of Austrian Social Security Institutions, their umbrella organisation. (Gaugg 2005 p. 101)

This is a compulsory form of insurance based on the solidarity principle. It is linked in particular to gainful employment, but there are also regulations for old-age pensioners and unemployed people. (Gaugg 2005 p. 102). Statutory health insurance is organised according to vocational groups and regional aspects, with some very wide variations in arrangements. Folgende Leistungen sind in der Krankenversicherung vorgesehen (Gaugg 2005 S. 103-111):

- Medical Aid
- Medications
- Hospital care
- Home nursing services and midwivesPsychotherapie und klinisch-psychologische Diagnostik
- Psychotherapy and clinical-psychological diagnosis Mutter-Kind-Pass-Untersuchungen
- Services of the medical-technical professions
- Mother-Child Medical Card examinations
- Health examinations and preventive medical check-ups
- Travel and transport costs
- Grants for prosthetic materials and auxiliaries
- Sickness benefits payments in cases of occupational disability through
illness
- Maternity benefits
- Social accident insurance
- The nursing care scheme

Private health insurance

About one-third of the Austrian population pays premiums into a private supplementary insurance policy in addition to their social security contributions. Such insurance products may afford the insured person better accommodation (single rooms, for example) in the hospital, coverage of the costs of treatment by a doctor of choice, payment of daily benefits in cases of illness, or the assumption of costs for complementary medical treatment procedures.
The private health insurance premiums are calculated according to actuarial principles and are partly tax-deductible. The number of persons privately health-insured has decreased over the past ten years. (Gaugg 2005 p. 107)

Health care units


Outpatient medical care

The outpatient medical care of the Austrian population is in the hands of 18,025 (status: December 31, 2004) registered general practitioners (i.e. doctors of general medicine) and specialists (including dentists) who are mainly in private practice. (Gaugg 2005 p. 51)

The majority of doctors in private practice have a contract with one or more social insurers. The reason these contracts are so important for doctors is because approximately 98 percent of the population is covered by social health insurance (Gaugg 2005 p. 51)

Primary medical care is provided by the 6,221 general practitioners (family doctors), who should be the first contact in case of illness. If specialised examinations or treatments should be necessary, the general practitioner refers the patient to a specialist in this field or to an outpatient clinic. (Gaugg 2005 p. 51)

Hospitals
The inpatient medical care of the Austrian population is provided by 275 hospitals, of which 272 – with around 67,000 beds actually set up – provided data in 2003 (as of December 31, 2003) Therefore, the following figures refer to these 272 hospitals. In terms of the population, the bed density amounted to 8.4 per 1,000 inhabitants. In the year 2003, the hospitals cared for around 2.5 million inpatients. More than two-thirds of all Austrian hospital beds (70.3 percent) are maintained by 133 public hospitals. In addition, there are 27 private hospitals (having 7.8 percent of the beds) which similarly operate on a non-profit-making basis. Thus, the total of non-profitmaking hospitals amounts to 160 (58.8 percent having 78.1 percent of the beds). (Gaugg 2005 p. 53)



More than two-thirds of all Austrian hospital beds (70.3 percent) are maintained by 133 public hospitals. In addition, there are 27 private hospitals (having 7.8 percent of the beds) which similarly operate on a non-profit-making basis. Thus, the total of non-profitmaking hospitals amounts to 160 (58.8 percent having 78.1 percent of the beds). (Gaugg 2005 p. 53)

The hospitals are funded by a variety of bodies, the largest of which being the provinces and/or the provincial associations with 32.7 percent of the hospitals and 52.3 percent of the beds. Others include municipalities, religious associations, statutory health insurance institutions, insurance companies and private persons. (Gaugg 2005 p. 53)


Financing and Funding

DRG-based funding by provincial health funds (Landesgesundheitsfonds, formerly Landesfonds) applies to hospitals with public law status (see below), general and specialized, and private general hospitals for public benefit (running on a non-profit basis). The provincial health funds all draw upon the resources of the federal government, the provinces, local authorities and the social insurance system. The data sets of the hospitals directory show whether a hospital is funded by a provincial health fund.

DRG-based funding by the private hospitals fund (PRIKRAF) applies to sanatoria (private hospitals run for profit). This fund draws upon the resources of the social insurance system to pay for services carried out in these hospitals that are covered by social insurance. The data sets of the hospitals directory show whether a hospital is (co-)funded by the private hospitals fund.

Non-DRG-based funding from other sources applies to various specialized care institutions, especially rehabilitation centres and long-term care institutions. Some of those hospitals are funded by social insurance institutions; most of the others have individual contracts with social insurance agencies. The data sets of the hospitals directory show whether a hospital is included in this group. (Source: Auer 2006, p. 9)
The table below is intended to illustrate relationships between and distribution of the characteristics described above (Source: Auer 2006, p. 9).



Visit the Austrian Hospital Compass for further Information: http://www.spitalskompass.at



Helpful Links

Association of austrian social insurance agency / Social-Net

AGES – Austrian Agency for Health safety nutrition

WHO Collaborating Centre for Health Promotion in Hospitals and Health Care

International Network of health supporting Hospitals

Quality in Hospitals

Representation of midwifes in Austria

Surfmed – Platform für health

Comparison of health systems in europa

Health support in Hospitals and in Spitälern and nursing homes– Informationnetwork Austria