In 2016, total healthcare expenditure in Austria according to the Organisation for Economic Co-operation and Development system of health accounts accounted for €39.597 billion, or 11.2 per cent as a share of the Austrian gross domestic product (GDP). After that, health expenditure amounted to €36.877 billion and gross capital formation in healthcare provider industries contributed €2.720 billion to the total expenditure on healthcare. Austrian healthcare expenditure (at current prices) increased on average by 5 per cent annually from 1990 to 2014. As a share of GDP, total health expenditure increased from 8.4 per cent in 1990 to 11.2 per cent in 2016. The figures for 2017 are not yet available.
Public current healthcare expenditure consists of general government expenditure, which includes expenditure by federal, state and local governments as well as social security funds. In 2016, public current expenditure on health amounted to €27.331 billion. Total public expenditure, which also takes gross capital formation into account, amounted to €28.723 billion and corresponds to a share of 74.2 per cent of total healthcare expenditure. The biggest share of general government expenditure on healthcare (43.7 per cent) was spent on inpatient care in 2016. The other main spending categories were outpatient care (23.8 per cent), pharmaceutical products, medical durables and non-durables (13.2 per cent), and home-based long-term nursing care (8.5 per cent).
In 2016, private households and private insurance enterprises spent €9.545 billion on healthcare. With a share of 34.5 per cent, the largest expenditure category of private households and private insurance enterprises was outpatient care. A further 26.3 per cent went to inpatient care, while the third-largest share (26.2 per cent) was spent on pharmaceutical products, medical durables and non-durables.
Healthcare expenditure by private households and insurance enterprises grew from €2.576 billion in 1990 to €9.545 million in 2016.
In total, 75.6 per cent of current health expenditure was financed by public sources. Private households, insurance enterprises, non-profit institutions and corporations financed altogether 24.4 per cent of current healthcare expenditure.
All those insured by the social health insurance system have a legal entitlement to benefits in kind and cash benefits within the legal framework of the specified (wide) range of benefits. Alongside statutory obligatory benefits, the health insurance funds also provide various levels of voluntary benefits according to their statutes, such as in the field of prevention.
Those covered by health insurance can choose freely between physicians in the outpatient sector, the majority of whom work in individual practices. In addition, approximately 900 outpatient clinics and hospital outpatient departments offer outpatient care. In 2018, about 36 per cent of the approximately 20,600 self-employed physicians in private practice have a contractual relationship with one or more health insurance funds. Around 64 per cent work as non-contracted physicians. Insured persons who consult non-contracted physicians are reimbursed with 80 per cent of the fee that the health insurance funds would pay to the contracted physicians. The population density of practising (employed and self-employed) physicians is around 5 per 1,000 inhabitants, but there is a considerable variation in this figure between the nine states.
Outpatient physician treatment is financed by (mandatory) insurance contributions, the premiums from private supplementary insurance and co-payments of private households. The payment of physicians in private practice is, in principle, set so that operating costs and investments for the practice can be amortised. The physicians’ chambers at state level negotiate annual general agreements with the Federation of Austrian Social Security Institutions on the provision of contracted physician services. This has to be approved by the individual health insurance funds. The general agreements include, in particular, payment regulations, agreements on service volumes and a capacity plan (location plan). On this basis, individual contracts are awarded to those physicians in private practice in accordance with the location plan. Contracted physicians receive a mixture of their capital payments for basic services and a fee-for-service payment for services that go beyond the scope of basic services. The distribution of these payment elements varies according to speciality, state and partly due to the type of health insurance fund. In part, agreements on volume limitations for physicians’ services are combined with decreasing payment scales. In principle, the utilisation of resources in the outpatient sector is subject to monitoring by the supervisory physicians or head physicians employed by the health insurance funds.
Hospitals that are listed in the hospitals plan of a federal state (fund hospitals) are subject to public law and have a statutory requirement to provide care and admit patients. They are entitled to legally prescribed subsidies from public sources for investment, maintenance and operating costs. The ratio of 7.7 beds per 1,000 persons is clearly above the EU average. The admission rate of 26.6 per 100 inhabitants is one of the highest in the EU.
Public and non-profit hospitals, which are licensed to provide acute inpatient care in the hospitals plan of the respective province, have a mandate to provide care to all inhabitants. In return, they have a right to subsidies and to the reimbursement of operating costs. The expenditure on these hospitals amounts to around €12.2 billion. Approximately 45 per cent is financed by social health insurance funds, 7.5 per cent by private insurance (for better accommodation), and 3 per cent by private households by means of co-payments and out-of-pocket payments. A further 10 per cent is financed by budgeted funding from the federal government, the states and local authorities. The remaining amount of approximately 35 per cent is borne by the owners of public hospitals, that is, from the states or private non-profit organisations.
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