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Population Insurance Coverage For A Core Set Of Healthcare Services (%) (2019):
Public Coverage: 100%; Primary Private Health Coverage: 0%; Total: 100%
*“Population coverage for health care is defined here as the share of the population eligible for a core set of health care services – whether through public programmes or primary private health insurance. The set of services is country-specific but usually includes consultations with doctors, tests and examinations, and hospital care. Public coverage includes both national health systems and social health insurance. On national health systems, most of the financing comes from general taxation, whereas in social health insurance systems, financing typically comes from a combination of payroll contributions and taxation. Financing is linked to ability-to-pay. Primary private health insurance refers to insurance coverage for a core set of services, and can be voluntary or mandatory by law (for some or all of the population.”
Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.
“Publicly financed coverage is virtually universal, covering over 99% of the population. A very small part of the population (0.2% in 2011; VVO, 2012) is not publicly covered because, since 2000, some self-employed occupational groups (such as physicians, chemists, architects, lawyers and notaries) have been allowed to opt out of the statutory scheme as long as they purchase substitutive private health insurance instead.
“The publicly financed benefits package is comprehensive and includes basic dental services. The extent of user charges is small. The most common user charge is the Rezeptgebühr (prescription charge), a flat-rate (annually valorized) copayment of €5.55 (2015) for each package of a reimbursable drug. People with low incomes are exempt, as are some other patient groups such as asylum seekers, and an overall cap is generally in effect at 1% of annual income (Rezeptgebührenobergrenze). Civil servants and the self-employed must pay 20% coinsurance for outpatient services (reduced to 10% for self-employed people who enter a prevention programme). Deductibles are applied to some forms of dental care.”
Source: Thomas Czypionka and Clemens Sigl. “Austria.” In Voluntary health insurance in Europe: Country experience [Internet]. Sagan A, Thomson S, editors. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2016. Observatory Studies Series, No. 42.
“Health insurance legislation defines that SHI [Social Health Insurance] coverage protects individuals from risks of illness, inability to work, and it provides benefits and health care in the event of motherhood. The minimum benefits package is determined by law, irrespective of the SHI fund and the law governing mandatory insurance (see Table 3.5). The collective contracts between SHI funds and physicians define the services covered. Except for pharmaceuticals, there are no explicit positive lists specifying which services or products have to be covered by SHI. Negative lists do not exist either.”
Source: Bachner F, Bobek J, Habimana K, Ladurner J, Lepuschütz L, Ostermann H, Rainer L, Schmidt A E, Zuba M, Quentin W, Winkelmann J. Austria: Health system review. Health Systems in Transition, 2018; 20(3): 1 – 256.
“In case of sickness absence of an insured employee, the employer continues to pay 100% of the gross employee salary or wage for a period of six to 12 weeks (depending on the duration of employment at the current employer). After this period the share of the employer is reduced to 50% for another four weeks, with the remaining 50% complemented by a sickness benefit paid by the SHI [Social Health Insurance]. Thereafter, the SHI fund pays a sickness benefit, equivalent to 100% of gross the employee salary or wage, for a period of at least 6 or 12 months, depending on the duration of insurance coverage (BKA, 2018c).
“In addition to the minimum benefits package, SHI funds may cover certain complementary benefits. SHI funds have no legal obligation to offer these benefits, and they do so according to their available resources. Voluntary ASVG services include certain cosmetic treatments (Article 133, ASVG), health consolidation measures and illness prevention (Articles 155, 156, ASVG), or a funeral costs award (Article 116, paragraph 5, ASVG). Within their statutes, SHI funds may also provide additional services, such as preventive services, reimbursing travel expenses for carers, or extending eligibility for illness benefits.”
Source: Bachner F, Bobek J, Habimana K, Ladurner J, Lepuschütz L, Ostermann H, Rainer L, Schmidt A E, Zuba M, Quentin W, Winkelmann J. Austria: Health system review. Health Systems in Transition, 2018; 20(3): 1 – 256.
“The Austrian health care system is characterized by a mix of selective and collective contracts between purchasers and service providers. In particular, the purchaser–provider relations can be distinguished between relatively active purchasing in the ambulatory (extramural) sector and passive purchasing in the inpatient sector.
“In the ambulatory sector, collective contracts are regularly negotiated between medical chambers (either the Austrian Medical Chamber or regional medical chambers – on behalf of independently practising physicians) and the HVB (on behalf of the SHI funds). This means that in fact every SHI fund negotiates its own collective contract. These contracts specify and regulate the catalogue of services, associated tariffs, payment mechanisms, service volumes, and the number of contracted providers. Physicians are awarded a contract with SHI funds based on collective contracts and regional staffing plans, which regulate the number of contracted practitioners per discipline and per region (Waldner, 2001; HVB, 2017j). Many practising physicians have a contractual relationship with one or more health insurers.
“Physicians not included in these plans are not subject to collective contracts and hence have no contract with SHI funds. However, these may charge fees that are above those stipulated in the collective contract for which patients can claim reimbursement for up to 80% of the service fee that would have been paid to a contracted practitioner. Private health insurance may cover the difference between non-contracted provider fees and those reimbursed by SHI.
“Collective contracts with other health providers (e.g. orthopaedic shoemakers) can be concluded by the Austrian Chamber of Commerce (Wirtschaftskammer Österreich). Collective contracts with the Austrian Chamber of Pharmacists (Österreichische Apothekerkammer) are regularly negotiated and regulate prescription fees, billing and dispensing details for medicines. Some outpatient clinics (Ambulatorien), which are legally considered to be hospitals, can choose to either conclude selective contracts or can accept the general collective contract for independent physicians with health insurance funds (only outpatient clinics that provide MRI and/or CT are required to conclude collective contracts). Also the new primary health care units initially concluded selective contracts but a collective contract is currently under negotiation and may replace these selective contracts in the future. In the inpatient sector, all hospitals are contracted collectively by the SHI funds, regardless of whether they are publicly or privately owned, but are reimbursed by the LGF. Hence, the Länder play a more important role in the purchasing of inpatient care than SHI funds. SHI funds are passive purchasers of inpatient services as they pay a lump sum to LGFs earmarked for hospital financing and are at the same time legally required to contract all hospitals that are authorized within the Regional Structural Plans for Healthcare (see section 2.8.2).”
Source: Bachner F, Bobek J, Habimana K, Ladurner J, Lepuschütz L, Ostermann H, Rainer L, Schmidt A E, Zuba M, Quentin W, Winkelmann J. Austria: Health system review. Health Systems in Transition, 2018; 20(3): 1 – 256.
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Page last updated July 21, 2022 by Doug McVay, Editor.
