Essentials of the Austrian-Health Care System
Prepared by: PP-15 Johanniter Austria Research and Education – (JOAFG), AustriaINFORMATION ABOUT THE TRAINING PROGRAMME
1. Training name
Essentials of the Austrian Health Care System
2. General description
The Austrian health care system is a complex and historically grown system. The goal of this course is to provide an overview of key areas of the Austrian health care system.
Objectives of the training:
- to introduce basic structures and institutions of the health care system in Austria
- to create awareness for relevant legal regulations and to give an overview on the Principles of the Austrian health care system
- to cover some Fundamentals of E-Card und ELGA
- Basic structures and institutions of the health care system in Austria
- Relevant legal regulations
- Principles of the health care system
- Austrian health targets
- Fundamentals of E-Card und ELGA
CONTENTS OF THE TRAINING PROGRAMME
Lesson #1: Foundations and outline: Health Care System Austria
Lesson #2: Overview of the responsible institutions in the health care system
Lesson #3: E-Card and ELGA
References
Quiz
Lesson #1: Foundations and outline: Health Care System Austria
The Austrian social insurance system has a long tradition; it is an evolved system, which has already undergone some adaptions and changes. The Austrian health care system is part of the Austrian social security system. The roots of the current system go back to the turn of the 19th/20th century. Early approaches to social security date as far back as the Middle Ages (e.g. welfare for the poor). (cf. Mittermann, 2018).
The legal framework of the social insurance system in Austria is the General Social Insurance Act (ASVG). The Act comprises health insurance, work accident insurance and pension insurance (cf. RIS - Rechtsinformationssystem, 2021).
The illustration provides an outline of the structure of the Austrian social insurance system, after the health insurance funds (formally: regional health insurance funds) have been joined in January 2020.
Figure 1: cf. Österreichische Sozialversicherung, 2021; own illustration
1.1 Key data on the Health Care System in Austria:
- Life expectancy at birth in Austria (vgl. BMASGK, 2019): 81,6 years – (EU-average 80,9 years)
- Healthy life years: 58 years for females and 56,7 years for males (EU-average 65,1 years for females and 64,2 years for males) (see Fig. 2 (eurostat, 2021)).
Figure 2: © eurostat, 2021
- Health care expenditures: about 10,2% of GDP (EU-average 8,7%) (BMASGK, 2019) of which about 8,9% is spent on health porotion and disease prevention measures (cf. Österreichische Sozialversicherung, 2019)
- Financing of services: The financing of healthcare as well as social services is complex and is mainly composed of compulsory social security contributions and general tax revenues. Overall, public resources finance about 75% of current health care spending. Approximately
The percentage of OOP, however, is above the EU average of 15% (cf. BMASGK, 2019).
Figure 3: (cf. BMASGK, 2019; own illustration)
- The emphasis of health care in Austria is on intramural care. This means that the primary focus of health services and health care is clearly on the inpatient sector. Therefore the Austrian health care system is cost-intensive and results in relatively high expenditure on the health care system (cf. BMASGK, 2019).
1.2 Principals of the Austrian Health Care System
Principal fo statutory insurance
- Insurance coverage comes into force either obligatory due employment, co-insurance or self-insurance. The contributions are compulsory by law; the amount depends on the income. Self-employed persons, however, must pay the prescribed contributions by themselves (cf. BMASGK, 2019; cf. gesundheit.gv.at, 2021).
Principle of solidarity and self-governance
- Solidarity principle: in Austria, the principle of compulsory insurance applies, which means that there is no competition between insurance providers. All insured individuals are legally entitled to “solidarity-financed benefits”. Additional, contributions are structured according to the amount of income and independent of the individual risk (cf. BMASGK, 2019). The principle of self-administration applies to the social insurance institutions, meaning that the social insurance institutions carry out administrative tasks free of instructions. The legal basis for this is enshrined in the Federal Constitution (cf. Österreichische Sozialversicherung, 2021).
- In general, in Austria every insured person has the freedom of choice on medical practitioner. Restriction to this freedom of choice may nevertheless exist due to structural factors (urban-rural areas) (cf. BMASGK, 2019)
Lesson #2: Overview of the responsible institutions in the health care system
Figure 4: Responsibilities of the institutions relevant for the health care system at a glance (cf. BMASGK, 2019; own illustration)
2.1 Federal Ministry of Social Affairs, Health, Care and Consumer Protection
The Federal Ministry of Social Affairs, Health, Care and Consumer Protection (BMSGPK) is responsible for:
- The fundamental health policy
- The protection of the health of the population
- Regulation of health professions
- Regulation of the pharmacy and pharmaceutical industry
- The legislation and supervision of social insurance institutions
2.1.1. The Austrian National Public Health Institute (Gesundheit Österreich GmbH - GÖG)
Is a national research and planning institution owned by the BMSGPK. The GÖG´s business areas include the Federal Institute for Health Care (ÖBIG) as well as the Federal Institute for Quality in Health Care (BIQG) and the Fonds Gesundes Österreich (FGÖ) (cf. BMASGK, 2019). Learn more about GÖG at: https://goeg.at/
2.1.2. Austrian Agency for Health and Food Safety Ltd. (Die Österreichische Agentur für Gesundheit und Ernährungssicherheit GmbH - AGES)
The AGES is a joint enterprise of the BMSGPK and the Federal Ministry of Agriculture, Regions and Tourism. AGES is responsible for supporting the federal ministries with regard to public health, animal health, food safety, drug safety, food security and consumer protection along the food chain. The legal basis for this is §8 of the Health and Food Safety Act (GESG). The Austrian Federal Office for Safety in health Care, BASG for short, is a field of activity of AGES and is responsible for the markeding authorization of medicinal products and the assessment of their efficacy (cf. BMASGK, 2019). Learn more about AGES at: https://www.ages.at/startseite/#
2.1.3. ELGA GmbH
ELGA GmbH were established in 2009 as a joint institution of the federal government, the provincial government and the social insurance system with the aim of introducing, implementing and further developing the electronic health record called „ELGA“ (cf. BMASGK, 2019) Learn more about ELGA at: https://www.elga.gv.at/ also see chapter 3-„E-Card und ELGA“
2.2 The Federal States
The federal provinces are responsible for:
- implementation of laws and enforcement in the intramural sector (hospitals)
- preclinical emergency care in cooperation with the municipalities
- essential legislation and enforcement in the social sector, including nursing and long-term care (cf. BMASGK, 2019)
2.3 The Social Insurance Institutions
The Social Insurance Institutions are responsible for determining the benefits and financing of extramural care:
- Medical or therapeutic care in the community setting
- Rehabilitation
- Medication
For this purpose, services are regularly assessed and catalogs of services are drawn up. Corresponding contracts are negotiated with practicing institutions, medical or therapeutic professional associations (e.g. Ärztekammer – medical association) (cf. BMASGK, 2019).
2.4 Collaboration between the Federal Government and the States
The legal foundations for cooperation and responsibilities between the Federal Government and the provinces are provided by agreements pursuant to Art. 15a B-VG of the Federal Constitutional Law (B-VG = Bundesverfassungsgesetz) (cf. BMSGPK, 2021)
2.4.1 Federal Targeting Commission
The Federal Target Steering Commission, established in 2013, with the aim of improving coordination and responsibilities in health care. The Commission operates on an agreement under Article 15a of the Federal Constitution. Elaborate guiding principles and setting priorities are the fields of duty of the Federal Target Steering Commission (cf. BMASGK, 2019).
2.4.2 Austrian Health Targets
In 2011, the process of developing Austria-wide health targets was launched a presented to the public in 2012. The ten health targets developed serve as an overarching framework for action until 2032. The overriding goal is to increase the number of healthy life years of people living in Austria (cf. BMSGPK, 2021b).
The 10-Health Targets are (BMSGPK, 2021b):
- To provide health promoting living and working conditions for all population groups through cooperation of all societal and political areas
- To promote fair and equal opportunities in health irrespective of gender socio-economic group, ethnic origin and age
- To enhance health literacy in the population
- To secure sustainable natural resources such as air, water and soil and healthy environments for future generations
- To strengthen social cohesion as a health enhancer
- To ensure conditions under which children and young people can grow up as healthy as possible
- To provide access to a healthy diet for all
- To promote healthy, safe exercise and activity in everyday life through appropriate environments
- To promote psychosocial health in all population groups
- To secure sustainable and efficient health care services of high quality for all
Lesson #3: E-Card and ELGA
The e-card and ELGA are central building blocks regarding access to the health care system as well as transparency of the health care services used and administration of important documents such as discharge letters from the hospital, laboratory findings or findings from imaging diagnostics (e.g. X-rays)
3.1 The „E-Card“
The e-card is the "personal key" for access to health care in Austria and within the EU or in all countries with which corresponding agreements with Austria exist. The e-card contains the name of the insured person, the personal social security number and, since recently, a photo as an additional security feature. On the back is the European Health Insurance Card (EHIC), with which access to health care is possible in other EU countries or with all those countries with which Austria has concluded a social security agreement (cf. Österreichische Sozialversicherung, o. J.).
3.1.1 Validity of the E-Card
For the inland, the validity of the e-card is unlimited. An exchange of the card is only necessary if crucial data, such as the name, change or the card is damaged. The EHIC is different; once the expiration date has been reached for existing insurance coverage, a new e-card is automatically delivered (cf. Österreichische Sozialversicherung, o. J.).
3.2 ELGA – The Electronic Health record
Since ELGA GmbH was founded in 2009, the electronic health record in Austria has been continuously expanded and extended. The e-card fulfils the requirement for secure access to personal health data.
Authorized healthcare providers (GDAs) can view data from the ELGA portal for the duration of treatment or within a specified period of time and release new findings, discharge letters, etc.(cf. ELGA GmbH, 2021).
3.2.1 Who is a Health service provider regarding ELGA (GDA)
Health service providers in the sense of ELGA are precisely defined by law and currently include the following professional groups:
- Physicians
- Dentists
- Pharmacies
- Hospitals
- Nursing homes
3.2.2 Currently available functions of ELGA:
- Hospital discharge letters
- Laboratory and radiology results
- E-Medication
- E-vaccination passport
References
- BMASGK, B. für A., Soziales, Gesundheit und Konsumentenschutz. (2019). Das österreichische Gesundheitssystem Zahlen-Daten-Fakten.
- BMSGPK, B. für S., Gesundheit, Pflege und Konsumententschutz. (2021a). Rechtsgrundlagen der Zielsteuerung-Gesundheit ab 2017. https://www.sozialministerium.at/Themen/Gesundheit/Gesundheitssystem/Gesundheitsreform-(Zielsteuerung-Gesundheit)/Rechtsgrundlagen-der-Zielsteuerung-Gesundheit-ab-2017.html
- BMSGPK, B. für S., Gesundheit, Pflege und Konsumententschutz. (2021b). Gesundheitsziele. Gesundheitsziele Österreich. https://gesundheitsziele-oesterreich.at/gesundheitsziele/
- ELGA GmbH. (2021). ELGA. ELGA - Meine elektronische Gesundheitsakte. https://www.elga.gv.at/elga-gmbh/unternehmen-und-geschaeftsfuehrung/
- eurostat, S. E. (2021). Healthy life years statistics. https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Healthy_life_years_statistics
- gesundheit.gv.at. (2021). Gesundheitssystem—Krankenversorgung. Gesundheitsportal. https://www.gesundheit.gv.at/gesundheitsleistungen/gesundheitswesen/gesundheitssystem
- Mittermann, B. (2018, November 22). Geschichte der Sozialversicherung—Wie alles begann. Arbeit&Wirtschaft. https://www.arbeit-wirtschaft.at/geschichte-der-sozialversicherungen/
- Österreichische Sozialversicherung. (2019). Die Ausgaben für Gesundheitsförderung und Prävention steigen – Kurzfassung. SV. https://www.sozialversicherung.at/cdscontent/?contentid=10007.845217&portal=svportal
- Österreichische Sozialversicherung. (2021). Auf Zukunftskurs—Sozialversicherung neu. https://www.sozialversicherung.at/cdscontent/?contentid=10007.853016&portal=svportal
- Österreichische Sozialversicherung. (2021). Die e-card—Alle Infos im Überblick. https://www.sozialversicherung.at/cdscontent/?contentid=10007.844034&portal=svportal
- Österreichische Sozialversicherung. (2021). Selbstverwaltung. https://www.sozialversicherung.at/cdscontent/?contentid=10007.845568
- RIS - Rechtsinformationssystem. (2021a). RIS - Allgemeines Sozialversicherungsgesetz—Bundesrecht konsolidiert, Fassung vom 10.11.2021. https://www.ris.bka.gv.at/GeltendeFassung.wxe?Abfrage=Bundesnormen&Gesetzesnummer=10008147
- RIS - Rechtsinformationssystem. (2021b). RIS - Gesundheitstelematikgesetz 2012—Bundesrecht konsolidiert, Fassung vom 25.08.2021. https://www.ris.bka.gv.at/GeltendeFassung.wxe?Abfrage=Bundesnormen&Gesetzesnummer=20008120
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