3 Preface Preface Good heath is an invauabe asset. Iness and impairment due to disease may reduce peope s quaity of ife to a considerabe extent especiay if they have no access to adequate medica care. Austria has had a heath care system based on soidarity for a ong time. It ensures high-quaity medica care for a citizens, independent of their socia status or income. Buiding such a heath care system has not been easy: it is the resut of a ong, hard road; many peope have fought for it. We shoud never forget this when we tak about our heath care system, which is often praised at internationa eve. Being i is never peasant. Therefore it is crucia for the peope to know that they can rey on the Austrian heath care system and that medica care does not depend on their financia means. Aois Stöger Federa Minister of Heath 1
4 Facts & figures Facts & figures Key information Austria is a democratic repubic situated in centra Europe. It covers a territory of about square kiometres. Austria has nine provinces incuding Vienna as its capita. Since 1955 Austria has been a member of the United Nations. Austria joined the European Union in 1995 and adopted the euro (EUR) as its currency in Economy With a gross domestic product (GDP) of EUR per capita (2009) Austria is one of the richest countries in the word. Between 1980 and 2009 average growth of GDP was 3.9%. In 2009 tota GDP amounted to EUR biion. Between 2008 and 2009 Austria faced a nomina decine in GDP of 1.8% (in rea terms: 3.6%). For 2010 a growth of about 2.0% is expected. Austria ranked 14th in the UN Human Deveopment Index of 2007, which refects a high standard of iving. Demography In 2009 Austria had 8.36 miion inhabitants. Demographic forecasts predict that the popuation wi grow to more than nine miion by The chances for a ong and heathy ife in Austria have never been as good as today. In 2009 a newborn gir had a ife expectancy of 82.9 years and a newborn boy of 77.4 years. Over the past 30 years ife expectancy has increased by more than eight years whereas infant mortaity has decreased by more than 75%. The infant mortaity rate corresponded to 3.8 deaths per ive births in In 2008 a 60-year- 2
5 Facts & figures od man had a remaining ife expectancy of 21.3 years, and in the same year a woman aged 60 coud expect to ive for an additiona 25.1 years. Like the majority of the industriaised countries Austria faces the chaenge of an aging popuation. On the one hand, ife expectancy is increasing, and on the other, the fertiity rate is faing. In 2009 the number of chidren per women was In the same year women s average age at first birth was 28.0 years. Source: Statistics Austria Austria has one of the most generous systems of socia security services for chidren and famiies within Europe. In 2007 expenditure for these services amounted to 2.8% of GDP.
6 Facts & figures Famiies iving in Austria have the opportunity to choose among five modes of chidcare aowance: one income-reated mode and four modes offering different amounts of fixed monthy aowances. Combined with other benefits such as famiy aowance, maternity aowance and hardship reief for famiies, these federa measures hep reconcie job and chidcare duties. Demographic figures, 1999 and Popuation * Women Men Life expectancy at birth Women Men Popuation oder than 65 years * Popuation younger than 20 years * Fertiity rate * Annua average Source: Statistics Austria As a consequence of the growing share of edery peope the percentage of those in need of ong-term care has increased. This is aso refected in the number of persons receiving ong-term care benefits. Between 1998 and 2008 this share went up by about 31%, thus amounting to persons at the end of Heath care resources The Austrian heath care system is characterised by a high density of easiy accessibe heath care faciities. In 2008 a tota of 267 hospitas with about beds were avaiabe for in-patient care. At that point in time about physicians and more than other heath care professionas were empoyed in Austrian hospitas. 75% of the other heath care professionas worked in nursing care.
7 Facts & figures The density of physicians in Austria is above the European average and amounted to 5 physicians (incuding dentists) per inhabitants in In the same year the tota amount of practising physicians was , thereof were genera practitioners and about worked as speciaists. In addition, about physicians were in training. Some overap may exist between the different aforementioned groups due to physicians having mutipe training. By the end of 2008 about physicians (genera practitioners and speciaists) were sef-empoyed physicians working in their own practices. Together with more than 900 out-patient cinics they ensure higheve out-patient heath care. More than 75% of the Austrian popuation oder than 15 say that their genera state of heath is either very good (37.3%) or good (38.4%). Morbidity and mortaity The most common discharge diagnosis in Austria are maignant neopasms (80% cancer) for women and diseases of the circuatory system in the case of men. The atter is aso the most frequent cause of death in Austria, foowed by cancer and respiratory diseases. Most frequent diagnoses at hospita discharge, 2008 Maignant neopasms Diseases of the circuatory system Diseases of the muscuoskeeta system and connective tissue Injury, poisoning and certain other consequences of externa cause Diseases of the digestive system Diseases of the genitourinary system Diseases of the respiratory system Menta and behavioura disorders Diseases of the eye and adnexa Pregnancy, chidbirth and chidbed Source: Statistics Austria
8 Organisation Organisation A joint undertaking at nationa and regiona eves 6 Heath care in Austria is characterised by the cooperation of a arge number of actors. Competencies in the heath care sector are generay reguated by aw. The main actors with regard to heath at federa eve are the Austrian Pariament (which consists of the Nationa Counci and the Federa Counci), the Federa Ministry of Heath (BMG), the Federa Ministry of Labour, Socia Affairs and Consumer Protection (BMASK), the socia security institutions and advocacy groups (socia partners: empoyers and empoyees representatives, as we as professiona associations). As far as egisation and its enforcement are concerned, the Federa Government pays a centra roe; however, many competencies are deegated to the provinces or to the socia security institutions. The Federa Ministry of Heath prepares aws, is responsibe for the protection of the pubic heath as we as overa heath poicy and functions as faciitator between the different payers in the heath care system, and aso as decision maker and supervisory authority. The Federa Government is in charge of defining the egisation for outpatient care (physicians in individua practices). Responsibiity for inpatient care (provided in hospitas) is shared between the federa and the provincia eve: the Federa Government ays down the egisative framework whist the provinces are in charge of defining egisation on enforcement as we as ensuring impementation. A reguations regarding pharmaceuticas, pharmacies and medica devices as we heath professions (for exampe education of physicians) and structura poicy are the responsibiity of the Federa Government. Pubic heath services and administration are jointy provided by federa, provincia and oca authorities. In addition, the provinces are in charge of ensuring hospita care for their inhabitants as we as offering heath pro-
9 Organisation motion and prevention services. The oca governments are in charge of socia wefare benefits and services. Socia insurance in Austria The Austrian socia insurance system is based on the principes of sta tutory insurance, soidarity and sef-governance and is primariy funded through insurance contributions. It incudes the branches of heath, accident and pension insurance and consists of 22 socia security institutions with the Main Association of Austrian Socia Security Institutions (HVB) as their umbrea organisation. Source: Austrian Museum for Socia and Economic Affairs on behaf of HVB Statutory socia insurance means that insurance is compusory and based on egisation. Insurance is usuay inked to gainfu empoyment and thus begins automaticay; some groups (sef-empoyed and vountariy insured peope) have to appy for insurance, however. The amount of insurance contributions to be paid is independent of the persona risk of the insured. Due to the arge number of insured individuas the risk is spread effectivey.
10 Organisation 8 The principe of soidarity means that there is a compensating system for baancing out differences between persons with a higher need of protection and those in ess need of protection for exampe between ow and high income earners, empoyed and unempoyed peope, etc. In many cases, dependants may be insured free of charge. Usuay haf of the contributions are paid by the empoyer and haf by the empoyee. The contribution rate is 7.65% in the majority of cases. Heath insurance is compusory in Austria; affiiation to a certain heath insurance fund depends on the profession of the insured person. In addition, it may aso be inked to their pace of work or the pace of residence. Most dependants are insured free of charge. Apart from a few exceptions, it is not possibe for an insured person to choose their socia security institution. There is no competition between these institutions. Intensified cooperation in the heath care sector There are a number of instruments and approaches aimed at improving the cooperation among individua actors in the heath care system and aso between the different eves of heath care provision. Cooperation between out-patient care and in-patient care is promoted by means of a coordination and sanctioning mechanism, defined in the Agreement according to Artice 15a of the Federa Constitutiona Act, concuded by the Federa Government and the provinces every four years. The Austrian Heath Care Structure Pan (ÖSG) and the Regiona Heath Care Structure Pans (RSG) are key panning instruments in the heath care sector. These pans incude panning of resources across a eves of service provision. The staffing pan for physicians who are in a contractua reationship with heath insurance funds is another panning instrument. At federa eve the Federa Heath Agency with the Federa Heath Commission as its executive body and at regiona eve the Regiona Heath
11 Organisation 9 Funds with the Regiona Heath Patforms as their executive bodies were created to promote joint trans-sectora panning, steering and uniform funding in the heath care sector. In this context one of the tasks of the Federa Heath Agency is to monitor deveopments taking pace in the Austrian heath care system and to take an active part in panning and steering by defining principes for work in this area. Coordination activities between heath care actors are aimed at ensuring a high eve of service quaity as we as the most efficient use of avaiabe resources. The Federa Heath Agency is composed of representatives of the Federa Government, the provinces, the socia security institutions, representations of the municipaities and the oca governments, the Austrian Medica Chamber, church-owned hospitas, patient representatives as we as severa other appointed representatives. The Federa Heath Agency is managed by the Federa Ministry of Heath. At provincia eve the Regiona Heath Funds are responsibe for impementing instructions and principes communicated by the Federa Heath Agency and for distributing funds to pubic, private and nonprofit hospitas. The Regiona Heath Patforms are composed of representatives of the respective province, the socia security institutions, the Federa Government, the Main Association of Austrian Socia Security Institutions (without voting rights), the Austrian Medica Chamber, representations of oca governments as we as hospita organisations. Patients are directy represented in numerous bodies. Patient advocacy groups pay an important roe in decision making. Further reevant actors in the heath care system incude a number of providers of heath care services, heath care institutions, other ministries, pubic authorities (for exampe the Austrian Agency for Heath and Food Safety, AGES), patient representatives (see The Austrian heath care system), charities, research institutions such as Gesundheit Österreich GmbH (GÖG) and a arge number of private actors.
12 The Austrian heath care system The Austrian heath care system Easiy accessibe, affordabe and equitabe The main principes of the Austrian heath care system are soidarity, affordabiity and universaity. In Austria, heath care is based on a socia insurance mode that guarantees a inhabitants equitabe access to high quaity heath services irrespective of their age, sex, origin, socia status or income. Comprehensive socia heath insurance coverage is a major feature of the Austrian heath care system: 99% of the popuation is protected. The Austrian heath care system is based on statutory socia insurance. Access to services is reguated by aw, the most important egisative basis being the Genera Socia Insurance Act (ASVG). A insured peope have a ega right to a arge number of benefits. Patients have access to a variety of services: primary heath care services provided by contract physicians of the Austrian socia heath insurance funds speciaised in-patient and out-patient care emergency care maternity services psychotherapy heath technoogy such as X-ray and aboratory tests physiotherapy, ergotherapy, speech therapy, curative massage and simiar therapies provided by heath professionas other than physicians denta services prescription medicines medica devices such as waking aids, wheechairs or bood gucose strips ambuance services 10
13 The Austrian heath care system mobie care and home care preventive and heath promotion services incuding vaccinations or screening examinations rehabiitation and ong-term care services care for peope with disabiities. Patients can choose their famiy physician and have free access to most other forms of medica care. Famiy physicians usuay have a contract with the socia heath insurance funds. In contrast to many other countries, there is no obigation in Austria to enro with a specific physician or to consut them prior to accessing speciaised (in-patient) treatment, that means physicians have no gate-keeping function. It is aso possibe to consut out-patient departments of hospitas without prior consent of the famiy physician or one s heath insurance fund. Apart from the main pubic payer, i.e. the Austrian socia heath insurance funds, major funders of the aforementioned benefits incude the Federa Government and the provinces, other socia security institutions or oca governments, which aso provide socia wefare services. 11
14 The Austrian heath care system 12 Take-up of seected heath care services may be inked to specia conditions or prerequisites such as age or type of iness or may aso invove co-payments. These may be fixed rates (e.g., a prescription fee for medicines, in 2010: EUR 5.0) or percentages (e.g., a 20% copayment for persons insured with certain heath insurance funds). Patients wi aso be faced with out-of pocket payments when using heath services which are not incuded in the benefits cataogue of their socia heath insurance fund. These incude, for instance, payments for OTC medicines, daiy aowances for in-patient care, expenditure for certain denta services or for the services of physicians who have no contract with the socia heath insurance fund in question. Payments made for the atter may partiay be refunded to the insured person by their socia heath insurance fund. For persons with specia needs or persons who are chronicay i a wide range of exemptions from co-payments exist. About a quarter of the insured popuation is exempt from paying the prescription fee for medicines. Equitabe heath care for a patients is of great importance for Austria: therefore individuas whose income is beow a defined monthy threshod (2010: EUR for singe persons; when suffering from a chronic iness EUR 901.6) are exempt from paying the prescription fee for medicines and from paying the daiy aowance that is charged for in-patient treatment. In addition, exemptions exist for individuas with certain notifiabe infectious diseases such as tubercuosis. The same appies to individuas fufiing aternative miitary service and their dependants as we as asyum seekers under government care. Another group of persons exempt from the prescription fee for medicines are those whose payments exceed a defined yeary imit (a person s annua expenditure for prescription medicines is imited to 2% of the annua income). For further information on financing see Financing and expenditure.
15 The Austrian heath care system In-patient care Heath care in Austria traditionay shows a strong emphasis on hospita care. In 2007 about 2.7 miion in-patient stays (incuding in-patient stays for one day or ess) were registered. With regard to the number of in-patient stays Austria ranks first in Europe: 28 in-patient stays per 100 inhabitants were registered in The average ength of stay is 5.7 days with the European Unionaverage being 6.1 days. Source: WHO In 2009 about hospita beds in 267 hospitas (132 of these are pubic and non-profit hospitas) were avaiabe for in-patient care of these beds were assigned to acute care. The density of
16 The Austrian heath care system acute care beds per inhabitants was around 6.3. Austria aso provides about paces for rehabiitation and more than paces in residentia faciities and nursing homes. In 2008, Austria had 267 hospitas incuding psychiatric institutions, about 800 out-patient cinics, 55 rehabiitation centres, 817 nursing homes as we as 29 geriatric day centres and 9 hospices. 14 Out-patient care Out-patient care for the Austrian popuation is mosty provided by sef-empoyed physicians running their own-practices. About a third of them have signed a contract with socia heath insurance. These contract physicians provide the majority of out-patient care services: in the year 2008, insured individuas consuted contract physicians about 6.8 times a year on average. In addition to contract physicians about 800 out-patient cinics exist in Austria, which are run either by the socia heath insurance funds or by private owners. To a certain extent, out-patient care is aso provided by the out-patient departments of hospitas, which however, are regarded as part of the in-patient sector, both financiay and as far as their organisationa structure is concerned. Out-patient services are aso provided by other heath care professionas such as psychotherapists or physiotherapists. The density of physicians is subject to regiona variation. Whereas the province of Burgenand had 3.6 physicians per inhabitants in 2008, Vienna had twice as many, namey 7.3 physicians per inhabitants. To improve out-patient care and to grant more patient-friendy opening hours as we as reducing waiting times, the introduction of group practices for physicians of the same or different medica speciaties was decided in 2010.
17 The Austrian heath care system Heath care resources Heath workforce in hospitas per 31 December 2008 Heath care professionas in hospitas (without physicians) Higher-eve services for heath care and nursing Nursing assistants Higher-eve and specia medica and technica workers Auxiiary medica care staff Midwives Physicians per 31 December 2008* A practicing physicians Genera practitioners Speciaists (without dentists) Dentists Empoyed physicians** Physicians in training In-patient care per 31 December 2008 Hospita beds Acute care beds Paces in residentia faciities and nursing homes Number of medicines for human use (incuding homeopathic products) per 31 December Dispensaries for prescription-ony medicines per 31 December 2009 Pubic pharmacies Hospita pharmacies 46 Dispensing doctors 950 Medica technoogy per 31 December 2008 Computed tomography scanners 99 Magnetic resonance imaging units 249 Gamma cameras 150 Positron emission tomography scanners 19 * Due to mutipe speciaisations some overap exists between groups of physicians. Empoyed physicians may aso work on a sef-empoyed basis in their own practice. ** Empoyed in hospitas, ambuatory cinics, schoos and other institutions Source: GÖG/ÖBIG 2010b; Statistics Austria 2010; ÖÄK 2010, ÖZK
18 The Austrian heath care system 16 Heath care personne Heath care services in Austria are provided by about peope working in the heath and socia care sector, two thirds of whom are women. A itte more than 20% of the work force are physicians, incuding those currenty undergoing training. Comprehensive protection by socia heath insurance as we as free choice of physician and a arge variety of affordabe high-quaity therapies. In 2009, Austrian hospitas empoyed about physicians, nurses, nursing assistants and auxiiary medica care staff, higher-eve and specia medica and technica workers such as radioogica staff or physiotherapists as we as midwives. Easy access to heath services is ensured by a nation-wide patient transport and emergency ambuance service with ambuance cars and about 35 heicopters. Provision of medicines Production, saes, marketing, pricing and reimbursement as we as dispensing of medicines is subject to specific ega reguations which are characterised by an orientation towards heath poicy and consumer protection. Austrian egisation is based on European Unionframework reguations. The Austrian Medicines Agency, AGES PharmMed, is in charge of marketing authorisation and post-marketing surveiance of medicines and medica devices as we as the approva of cinica studies. AGES PharmMed reports to the Federa Ministry of Heath (www.basg.at). Ony pharmacists with a management permit are entited to open and run a pharmacy in Austria. The Pharmacy Act reguates the materia preconditions for opening a pharmacy. Neither vertica nor horizonta
19 The Austrian heath care system integration is aowed. A pharmacies are privatey owned and serve as community pharmacies. Drugstores or supermarkets are not permitted to dispense medicines incuding OTC (over-the-counter) medicines. To guarantee quick access to medicines aso in rura areas around famiy physicians are aowed to dispense prescription medicines and OTC medicines to their patients. The provision of the comprehensive range of heath services across regions is ensured by various mechanisms: centra and regiona heath care panning a high degree of protection through statutory socia heath insurance for a provision of seected heath care services for peope who have no socia heath insurance access to first-rate medica care for a inhabitants free choice of physician and therapy a comprehensive range of heath promotion services and preventive services a high density of hospitas and physicians hoding contracts with socia heath insurance funds socia insurance contributions which are independent of the individua risk of the insured person. 17
20 Financing and expenditure Financing and expenditure Fair funding based on soidarity 18 Equa access to heath care services for a Austrian inhabitants, independent of their income, age, sex or origin, is guaranteed by the soidarity-based funding principe of the Austrian heath care system. The Austrian heath care system is primariy financed through a combination of income-based socia insurance contributions, pubic income generated through taxes and private payments in the form of direct and indirect co-payments. Socia insurance is the most important source of heath care funding, contributing around EUR 13.2 biion in 2007 (2009: EUR 14.1 biion - preiminary figures), which corresponds to about 50% of tota heath expenditure. Whereas out-patient care is amost entirey financed by socia heath insurance funds, expenditure for in-patient care is shared between the pubic sector and socia insurance. Long-term care services are mosty funded through taxes (see Facts & figures). In 2007, 10.3% of gross domestic product was spent on heath. This corresponds to about EUR 27.9 biion or EUR per capita. In 2007, about 76% of tota heath expenditure was generated from pubic sources. This incudes expenditure by socia heath insurance funds as we as by the Federa Government, the provincia and the oca governments. The remaining 24% is accounted for by private heath expenditure: out-of-pocket payments by househods, expenditure for private heath insurance companies and other private nonprofit organisations as we as expenditure by companies for services provided by occupationa heath physicians. The argest share of heath expenditure is spent for in-patient care, foowed by out-patient care. The figure beow shows the distribution of tota heath expenditure across its individua service areas in 2007.
21 Financing and expenditure Source: OECD 2010 Like the majority of the industriaised countries Austria has faced increases in heath expenditure. Between 1997 and 2007 tota heath expenditure per capita rose by an average of 2.7% in rea terms, meaning that Austria ranks beow the European Union-15 average rate of 3.8%. In 2007, tota heath care expenditure in Austria amounted to around EUR 27.9 biion, which is 10.3% of gross domestic product, which positions Austria third among a European Union Member States. 19
22 Financing and expenditure Distribution of heath expenditure in miion euro, 2007 Pubic expenditure Private expenditure Tota In-patient care Out-patient care Out-patient denta care Long-term care * Anciary services to heath care ** Medica goods dispensed to out-patients Prevention and pubic heath services Heath administration Current expenditure on heath Investments Tota expenditure on heath * incudes expenditure for in-patient ong-term care, day care services, home care services; incudes financia ong-term care benefits provided by the the federa and the provincia governments; ong-term care expenditure is mainy based on estimates. ** incudes expenditure for services such as cinica aboratory tests, imaging procedures, X-raying, patient transport and emergency rescue. Source: Statistics Austria 2010, based on the OECD System of Heath Accounts In addition to its societa and socia reevance, the Austrian heath care sector aso represents a significant economic factor. According to a recent pubication by the Institute for Advanced Studies (IHS) heath care expenditure in 2006 resuted in a net product of EUR 22.5 biion, which corresponds to a share of about 9.7% of Austria s entire vaue added, or in other words futime equivaents. 20
23 Financing and expenditure Source: OECD
24 High-quaity patient-centred care High-quaity patient-centred care Core eements of optimum heath care provision Quaity, transparency and orientation towards patients pay a very important roe in the Austrian heath care system. Patient rights are not ony egay defined but can aso be enforced by aw. Speciaised patient advocacies have been estabished in a provinces. They ensure patients rights and represent their interests and mediate in conficts. About support groups hep patients come to terms with disease and distress in addition to the wide range of professiona heath care services that is avaiabe. The Quaity Strategy for the Austrian heath care system wi ensure a common framework for a quaity initiatives existing in Austria. In addition to numerous projects in individua heath care institutions this incudes heath technoogy assessment, quaity registries, quaity reports and the compiation of quaity guideines. Integrating a reevant actors, coordination is taken over by the Federa Institute for Quaity in the Heath Care System (BIQG), a business unit of Gesundheit Österreich GmbH. These actors incude socia security institutions, federa ministries, provinces, professiona societies, chambers and professiona representations, patient advocacies and patient support groups. 22
25 High-quaity patient-centred care The Austrian Society of Medica Quaity Assurance and Quaity Management LLC (ÖQMED, which is fuy owned by the Austrian Medica Chamber, periodicay pubishes a Medica Quaity Report in which the resuts of its evauation of physician s practices are given. E-heath has become an integra part of the heath care system. In Austria any activities reated to e-heath are known under the term ELGA, which means eectronic heath fie. The introduction in 2005 of an eectronic heath insurance card (e-card) for a persons insured with a socia heath insurance fund was a key prerequisite for ELGA. It made it easier and ess bureaucratic for individuas to have access to heath care services provided in the context of the socia heath insurance system. ELGA permits a more efficient administration of heath information and may if patients agree in future hep prevent dangerous medication interactions. The pubic heath Internet porta offers reiabe and independent heath care information as we as many other services, such as a search function for physicians or hospitas. Information on how to ead a heathy ifestye can be found on websites of pubic institutions in the heath care sector (for exampe or This information is provided in ine with the needs of the popuation. The high degree of quaity and patient orientation contributes to overa satisfaction among the popuation. According to a heath survey performed in a European Union-Member States 95% of the Austrian popuation beieves that the quaity of the heath care services provided in Austria is either very good or good this is the second highest rating among European Union Member States, after Begium (Eurobarometer 2010). 23