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Overview of Austria’s National Healthcare System

Population Insurance Coverage For A Core Set Of Healthcare Services (%) (2017):
Public Coverage: 99.9%; Primary Private Health Coverage: 0%; Total: 99.9%

Note: “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 (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

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Annual household out-of-pocket payment, current USD per capita (2017): $949

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed Jan. 10, 2020.
http://apps.who.int/nha/database/

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Out-of-Pocket Spending as Share of Final Household Consumption (%) (2017): 4.0%

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

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“The Austrian health system is complex and fragmented (see Figure 2.1): (1) responsibilities are shared between the federal and the Länder level; (2) many responsibilities have been delegated to self-governing bodies (social insurance and professional bodies of health service providers); and (3) health care financing is mixed, with the state (federal and Länder level) and social insurance funds contributing to the budget (see section 3.2).

“The federal level is primarily responsible for regulating social insurance and most areas of health care provision – except hospital care, where the federal level defines only the basics and the Länder are responsible for the specifics of legislation and implementation (see section 2.8). There are 18 SHI [Social Health Insurance] funds, including one for each of the nine Länder, which are joined together in the Main Association of Austrian Social Security Institutions (Hauptverband der österreichischen Sozialversicherungsträger, HVB) (including also the pension and accident insurance funds) (see section 2.3.3). SHI funds collectively negotiate with the professional body of physicians, the Austrian Medical Chamber (Österreichische Ärztekammer) and other health professions about health care provision in the areas of ambulatory (extramural) and rehabilitative care and pharmaceuticals.

“Efforts have been made for several years to achieve more joint planning, governance, and financing, by bringing together the federal and the Länder level and coordinating these with SHI funds. The establishment of state health funds (Landesgesundheitsfonds, LGF) that pool resources for the financing of hospital care at the Länder level in 2005 has contributed to more coordination in the financing of hospital care. More recently in 2013, the introduction of the B-ZK and nine State Target-Based Governance Commissions (Landes-Zielsteuerungskommissionen), bringing together representatives of the three major public financing agents (federal government, state governments and SHI funds), has improved coordination and governance of the health system (see section 6.1.2). In addition, joint planning of health care (see section 2.5) through structural plans for health care is becoming increasingly important and is starting to overcome its traditional focus on (specialized) hospital care by including also ambulatory (extramural) care planning.

“However, despite the establishment of joint governance and planning mechanisms, the constitutional decision-making powers of the various players have remained essentially unchanged. As a result, coordination continues to be a challenge – not only with regard to the provision of inpatient and ambulatory (extramural) care but also with regard to rehabilitation and long-term care (LTC) (see sections 5.7 and 5.8).”

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. http://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits/austria-hit-2018

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“The Austrian social insurance system has always been administered according to the principle of self-government, with the exception of the period 1939–1947. Self-governance of the social insurance system means that insurance-holders and those who pay contributions (employers), service users and health care providers participate indirectly in the administration of the system. Health care provision is organized through negotiations between the self-governing bodies of SHI funds and providers in all areas of health care provision except hospital care. Self-governing bodies of SHI funds consist of representatives of both employers and employees, and exist at the level of individual SHI funds as well as at the level of the HVB. Self-governing bodies of health service providers are – among others – the medical chambers and the Austrian Chamber of Commerce, as well as representatives of dentists, pharmacists and the voluntary professional associations of other health professionals (e.g. nurses, technical staff).”

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.
http://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits
http://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits

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