Charles University
Faculty of Social Sciences, Institute of Social Studies
Department of Public and Social Policy
Prague 5, Jinonice, U Krize 8
Petr Hava
International comparison
of health care systems
and policies
Class 8: Austria
Winter 2012
1
Student´s texts
• Text1 Austria HIT summary 2006
• Text2 Austrian healtrh care system (2010)
• Text3 OECD 2007 How does Austria compare
• Text4 Statistical data OECD2007 (economic
globalization indicators)
• Text5 Economic survey of Austria OECD
2007
2
Land of Mountains, Land on the River
3
Geography
4
Austria - federal republic
Austria is divided into nine states (German: 'Bundesländer').
These states are then divided into districts (Bezirke) and cities
(Statutarstädte).
Districts are subdivided into municipalities (Gemeinden).
Cities have the competencies otherwise granted to both
districts and municipalities.
The states are not mere administrative divisions but have
some distinct legislative authority separate from
the federal government.
5
9 States
Capital
Population
[8]
Rank
State (Bundesland)
1
Burgenland
Eisenstadt
280,350
9
2
Carinthia (Kärnten)
Klagenfurt
560,753
6
3
Lower Austria (Niederösterreich)
St. Pölten
1,588,545
2
4
Upper Austria (Oberösterreich)
Linz
1,405,986
3
5
Salzburg
Salzburg
529,085
7
6
Styria (Steiermark)
Graz
1,203,986
4
7
Tyrol (Tirol)
Innsbruck
698,472
5
8
Vorarlberg
Bregenz
364,611
8
9
Vienna (Wien)
Vienna (Wien)
1,660,534
1
6
Selected links
•
Ministry of health
Bundesministerium für Gesundheit, Familie und Jugend
Radetzkystrasse 2
A-1031 Wien
Austria
WWW: http://www.bmgfj.gv.at
• WHO/Europe office in Copenhagen –
links to documents
http://www.euro.who.int/countryinform
ation/
Alois Steger,
Current
Bundesminister fur
…
• EUROSTAT
http://epp.eurostat.ec.europa.eu/portal
• Austrian Health Care System. Key Facts
http://www.bmgfj.gv.at/cms/home/attachments/2/1/2/CH1015/CMS12878554
95948/the_austrian_health_care_system_2010_e1.pdf
7
Good health is an invaluable asset. Illness and impairment due to
disease may reduce people’s quality of life to a considerable extent
– especially if they have no access to adequate medical care.
Austria has had a health care system based on solidarity for a
long time. It ensures high-quality medical care for all citizens,
independent of their social status or income. Building such a health
care system has not been easy: it is the result of a long, hard road;
many people have fought for it. We should never forget this when
we talk about our health care system, which is often praised at
international level.
Being ill is never pleasant. Therefore it is crucial for the people to
know that they can rely on the Austrian health care system and that
medical care does not depend on their financial means.
Alois Stöger
Federal Minister of Health
8
Overview
• Introduction
– Recent political history, history of the health care system
• Population, demography, health status
• Organizational structure overview
• Health care financing and expenditure
– Health care financing [main system: health insurance, complementary
sources, THCE as a % of GDP]
•
•
•
•
Health care delivery system
Payment of hospitals and physician
Health care reforms, challenges
Conclusions, discussion
9
Dual monarchy Austria-Hungary
10
political history
•
The political system of the Second Republic came to be characterized by the system of Proporz,
meaning that most posts of some political importance were split evenly between members of the Social
Democrats (Labour Party) and the People's Party (Conservatives).
•
Interest group representations with mandatory membership (e.g. for workers, businesspeople,
farmers etc.) grew to considerable importance and were usually consulted in the legislative process, so
that hardly any legislation was passed that did not reflect widespread consensus. The Proporz and
consensus systems largely held even during the years between 1966 and 1983, when there were noncoalition governments.
•
Austria nowadays has five major political parties:
– The SPÖ (Labour Party), the ÖVP (Conservatives), the "Greens" (Environmental,
social-liberal) and FPÖ/BZÖ (both right-wing, nationalist). SPÖ and ÖVP share about
75% of the parliamentary mandates, while the remaining 25% are divided between the
other three parties.
•
Austria became a member of the European Union in 1995
•
The major parties SPÖ and ÖVP have contrary opinions about the future status of Austria's military
neutrality: While the SPÖ pleads for a neutral role in the EU (together with other neutral EU members
like Sweden), the ÖVP argues for stronger integration into the EU's security policy; even a future NATO
is not ruled out by some ÖVP politicians. Since the "permanant neutrality" forms part of the Austrian
constitution, a two-thirds majority in the Austrian parliament would be needed.
Source: from wikipedia
11
Legislative actor*
• The Parliament of Austria (Parlament) consists of two
chambers.
•
• The National Council (Nationalrat) has 183 members,
elected for a five year term by proportional representation.
– It is the predominant of the legislature's two chambers.
• The politically much less significant Federal
Council(Bundesrat) currently consists of 62 members,
elected by the state legislatures (Landtage).
12
Main office holders (Nov 2012)
• Federal President
– Heinz Fischer SPÖ since 8 July 2004
• Chancellor of Austria
– Werner Faymann SPÖ since 2 December
2008
13
Recent political developments
•
•
•
•
•
After general elections held in October 2006, the Social Democrats emerged as the
largest party, whereas the People's Party lost about 8% in votes.
Political realities prohibited any of the two major parties from forming a coalition
with smaller parties.
In January 2007 the People's Party and Social Democrats formed a grand coalition
with the social democrat Alfred Gusenbauer as Chancellor. This coalition broke
up in June 2008.
Elections in September 2008 further weakened both major parties (Social
Democrats and People's Party) but together they still held more than 50% of the
votes with the Social Democrats holding the majority.
They formed a coalition with Werner Faymann from the Social Democrats as
Chancellor. The positions of the Freedom Party and the deceased Jörg Haider's new
party Alliance for the Future of Austria, both right-wing parties, were strengthened
during the election.
Source: http://en.wikipedia.org/wiki/Austria
14
AUSTRIA -Federal republic
• As a federal republic, Austria is divided into nine states
(German: Bundesländer).
• These states are then divided into districts (Bezirke) and
statutory cities (Statutarstädte).
• Districts are subdivided into municipalities (Gemeinden).
Statutory Cities have the competencies otherwise granted to
both districts and municipalities.
• The states are not mere administrative divisions but have
some legislative authority distinct from the federal
government, e.g. in matters of culture, social care, youth and
nature protection, hunting, building, and zoning ordinances.
In recent years, it has been discussed whether today it is
appropriate for a small country to maintain ten parliaments15
Economic and social development
• Austria is one of the 10 richest countries in the world in
terms of GDP per capita, has a well-developed social
market economy, and a very high standard of living.
• Until the 1980s, many of Austria's largest industry firms
were nationalised; in recent years, however, privatisation
has reduced state holdings to a level comparable to other
European economies.
• Labour movements are particularly strong in Austria
and have large influence on labour politics. Next to a
highly-developed industry, international tourism is the
most important part of the national economy.
16
SOURCE: http://www.oenb.at/isaweb/report.do?&lang=EN&report=7.7
Osterreichische Nationalbank
17
Source: OECD*
18
19
Income inequality, Gini coefficient
20
Population - demographics
21
22
Life expectancy and GDP
23
24
Total population and annual growth
25
Recent history of health care system
The Lander have their legislative competencies
and also participate in legislation at a federal level
in the Bundesrat [upper house of parliament]
Since 1990, almost all the indicators of the health
status of the population have improved
significantly
Since the nationwide introduction of mandatory
social health insurance has been extended and
now includes 98% of inhabitants
26
Organizational structure of the
health care system
Federalist structure of the country
Delegation of competencies to sefl-governing
subjects/actors/citiezens in the social insurance
system (public corporation of citizens)
As well as by cross-actors structures at federal
and Lander level which possess competencies in
cooperative planning, coordination and
financing
27
28
Health care financing and
expenditure
• Financing is pluralistic
– The social health insurance system [45,3%]
– Federal government, the Länder and local
authorities [25%]
– Privately [25%]
• In 2004, Austria spent 9,6% of its GDP !!!
• And US$ 2257 per capita [versus US$
2951]
29
30
31
32
Austria
7.0
10.2
33
34
35
Rapid growth in the availability of diagnostic
technologies during the past decade
36
Real GDP growth
Avarage annual growth in percentage, 1992-2005
Austria 2%
37
Source OECD 2007
Health care delivery system
BALANCE OF:
• DECENTRALIZATION of public services
• INTEGRATION
– The public health service is the responsibility of the Lander,
which delegate tasks to district administrative or local
authorities
– In 1998, the Healthy Austria Fund was introduced, which
finances health promotion initiatives
– Since 2005, health promotion and prevention are also defined
as a subtask of the health platforms which manage the Lander
health funds [to steer health care provision and financing
across sectors]
38
39
40
Financial resource allocation
• Multitude of financing flows and forms of
financing
• Reflecting the plurality of financing and
service provision
• Advantages and disadvantages of such
plurality and current approaches how to
solve problems [disadvantages]
44
45
Payment of hospitals
 The reimbursement of inpatient services
in public hospitals has been carried out on
the basis of the performance-orientated
hospital financing [LKF] since 1997.
This consists of a core component of
nationally uniform diagnosis related
groups [LDFs] and full control area which
takes the special characteristics of
hospitals into account and differs
according to the Land in question.
46
47
Payment of physicians
• The physicians chambers at Lander level
negotiate annual general agreements with
the Federation of Austrian Social Insurance
Institutions [payment regulations, agreements on
service volumes and capacity plan]
• Outpatient physician: mixture of per capita
payments for basic services and fee for service
payment for services which go beyond the scope
of basic services
48
Health care reforms
• Primarily dealt with
– cost containment
– Structural reforms to improve the planning of
capacities
– The cooperation of stakeholders
– Coordination of financial flows
• The reimbursement of services and medicines
have been more strongly linked to health
technology assessment
• Contribution revenue has been increased
• Quality assurance requirements have been
raised and patients rights have been
strengthened
49
Conclusions, discussion
• In the last 25 years, the actors in health care system
have succeded by means of cooperative agreements
and planning in ensuring almost universal health
care provision with a comprehensive benefit
catalogue
• Sectoral fragmentation, which creates bias toward
hospital care, is a long standing weakness [allocative
efficiency problem]
• The planning, structures and funds introduced since
2005 permit for the first time the cross-sectoral
steering of capacities and financing flows
50
Literature
Hofmarcher, M.M., Rack, H.M. Austria: Health
system review. Health Systems in
Transition, 2006; 8[3]: 1-247
Austria HIT summary (2006)
http://www.euro.who.int/__data/assets/pdf_file/0005/98825/E89021su
m.pdf
The Austrian Health Care System (2010)
http://www.bmgfj.gv.at/cms/site/attachments/9/6/4/CH0993/CMS12796
28568913/the_austrian_health_care_system_2010_e1.pdf
51