Private Health Insurance with a Focus on the Austrian Modell

Private Health Insurance with a Focus on the Austrian Modell

Private Health Insurance (PHI) PHI acts within a field of great social relevance: Health steadily ranks among the top concerns of population

Private Health Insurance (PHI) Political consensus that access to medicine shall be independent from wealth thus the economic risk for being sick shall be shared in solidarity

Private Health Insurance (PHI) The state organizes systems of solidarity, either national health services (Beveridge), or social insurance bodies (Bismarck) to be referred to as Legal Health Insurance (LHI)

Private Health Insurance (PHI) The amount of self insurance or PHI is determined by the intensity of LHI

Private Health Insurance (PHI) What is PHI? Here: a business performed by a private enterprise with the intention of making profit!

Private Health Insurance (PHI) Motivation for accepting PHI: Politics getting more money into the system reduce state spendings get transfers fighting black market by introducing a legalized market freedom of choice

Private Health Insurance (PHI) Motivation for accepting PHI: People Expectations of getting more benefits (better access, better care...) cover copayments of LHI

Private Health Insurance (PHI) Motivation for accepting PHI: PHI enterprises a business modell allowing for profit (transparency of benefits, suffiecient volume, insurability, stable legal framework)

Private Health Insurance (PHI) Ideal types of PHI level of benefits PHI LHI population 100%

Private Health Insurance (PHI) LHI is exhaustive (covering all necessary benefits) PHI covers higher benefits with luxury appeal (better rooms, complementary medicine...)

Private Health Insurance (PHI) LHI is exhaustive, but there are copayments PHI covers copayements

Private Health Insurance (PHI) LHI is exhaustive only in theory, in reality there are deficiencies PHI acts in grey area or becomes a duplicate insurance

Private Health Insurance (PHI) LHI is officially non exhaustive, but covers only basic needs PHI covers more than luxury benefits

Private Krankenversicherung level of benefits LHI PHI population 100%

Private Health Insurance (PHI) LHI covers only part of population (who needs social security) PHI is open for the remaining part

Private Health Insurance (PHI) in reality: mixed modells substitutive PHI is under political pressure

Private Health Insurance (PHI) tendency for pseudo -substitutive PHI PHI is allowed to enter the market of basic insurance PHI and LHI compete PHI has to adopt principles of LHI profitability is reduced

Private Health Insurance (PHI) Conclusions: complementary and duplicate PHI tend to be more profitable substitutive PHI tends to be of bigger volume, but of less (if any) profitability

AUSTRIA

Social Health Insurance

Social health insurance Social health insurance is a compulsory insurance based on the solidarity principle financed by income dependent contributions up to a certain llimit the cover provided by the social health insurance extends not only to the insured themself but to member of their family, provided they do not pay contributions on their own name 99 percent of the population are covered by the social health insurance coverage extends to all necessary and useful treatments

Private Health Insurance

Private health insurance register 2,6 mio. insured person (that is 32% of the Austrian population) as substitute insurance (very small!) as complementary insurance for expenses and other expenditures, which are not covered by the social insurance hospital charges for private room in public hospitals and additional costs in private hospitals 1 mio insured persons (that is 13% of the Austrian population)

Principles of the private health insurance Principles of the private health insurance insurance for life no regular cancellation by the insurer premium includes the raising risk with raising age no premium increases because of raising age or illness possible, therefore

Principles of the private health insurance age provisions according to life insurance adaption of premium to costs, frequency of use, expectation of life risk assessment with additional premium, special waiting period, exclusion of insurance cover for preexisting conditions

Principles of the private health insurance insured under private law premiums calculated according to the principle of equivalence per insured person corresponding to the range of insurance cover, depend on the age of entry sex physical condition

Austrian Health Insurers 76 insurance companies are established in Austria 8 companies of them pursuit the health insurance UNIQA Personenversicherung Wiener Städtische Merkur Generali / Interunfall Versicherung Allianz Elementar Wüstenrot CallDirekt MUKI

market share 2007 Call Direct Generali Allianz 0,31% 13,15% 2,63% Sonstige 0,31% Merkur 13,69% UNIQA 48,35% Wr. Städt. 20,81% Premium: 1,5 billion EURO Quelle: Verband der Versicherungsunternehmen

classes of insurance The private health insurance offers insurance protection as insurance against loss or damage insurance of fixed sum

hospital expenses insurance In-patient hospital treaments special class the insurance covers benefits for medically indicated hospital stays due to illness, accident, or childbirth full guarentee of cost coverage and directly charging in a special class two bed room with partner hospitals full guarentee of cost coverage and directly charging in a special class two bed room in public general hospitals in Europe

association contracts with hopitals and physicans regulate prices and direct charging with best price clause (mostfavored status clause) = prerequisite for full guarentee of cost coverage about 170 partner hospitals multitude of negotiating partners (hospitals, physicans, communities...)

out patient treatment insurance coverage for outpatient treatment private physican Reimbursement is made for 80% or 50% of the costs of medically treatment indicated due to illness, accident or pregnancy up to an annual maximum sum out-patient medical treatment (including complementary medicine) day clinic treatments medically-indicated medicine (including homeopathic remedies)

out patient treatment medically-indicated auxiliaries (treatment aids) medically-indicated physiotherapeutic treatment (treatment aids), ergotherapy, logopedics medically-indicated psychotherapeutic treatment provided by persons who are authorised to practice psychotherapy independently for vaccinations (serum, medical fee) in accordance with vaccination recommendations of the senior Counsellor of Health (with the exception of travel vaccinations)

insurance of daily benefits during hospitalisation Hospital daily benefits double benefits after accidents for stays in a hospice a rate per day will be paid

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