International comparison of health care systems and policies

Class 8: AustriaWinter 2012

Charles UniversityFaculty of Social Sciences, Institute of Social Studies

Department of Public and Social Policy

Prague 5, Jinonice, U Krize 8

Petr Hava

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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

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Land of Mountains, Land on the River

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Geography

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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.

Austria - federal republic

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9 States

State (Bundesland)Capital Population [8] Rank

  

                                           

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

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Selected links• Ministry of health

Bundesministerium für Gesundheit, Familie und JugendRadetzkystrasse 2 A-1031 Wien Austria

WWW: http://www.bmgfj.gv.at

• WHO/Europe office in Copenhagen – links to documents http://www.euro.who.int/countryinformation/

• 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/

CMS1287855495948/the_austrian_health_care_system_2010_e1.pdf

Alois Steger, Current Bundesminister fur …

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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 Health8

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

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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 non-

coalition 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 wikipedia11

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).

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Main office holders (Nov 2012)

• Federal President– Heinz Fischer SPÖ since 8 July 2004

• Chancellor of Austria– Werner Faymann SPÖ since 2 December

2008

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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/Austria14

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.

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SOURCE: http://www.oenb.at/isaweb/report.do?&lang=EN&report=7.7Osterreichische Nationalbank

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Source: OECD*18

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Income inequality, Gini coefficient

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Population - demographics

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Life expectancy and GDP

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Total population and annual growth

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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

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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

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Austria 7.0 10.2

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Rapid growth in the availability of diagnostic technologies during the past decade

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Real GDP growth

Avarage annual growth in percentage, 1992-2005

Source OECD 2007

Austria 2%

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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]

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Financial resource allocation

• Multitude of financing flows and forms of financing

• Reflecting the pluralityplurality of financing and service provision

• Advantages and disadvantages of such plurality and current approaches how to solve problems [disadvantages]

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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.

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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

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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/

E89021sum.pdf

The Austrian Health Care System (2010)http://www.bmgfj.gv.at/cms/site/attachments/9/6/4/CH0993/

CMS1279628568913/the_austrian_health_care_system_2010_e1.pdf

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