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Austria: Health System Review 2006 Health Systems in Transition Vol. 8 No. 3 2006 Austria Health system review Maria M Hofmarcher • Herta M Rack European Editor: Annette Riesberg on Health Systems and Policies Health Systems in Transition Written by Maria M. Hofmarcher, Institute for Advanced Studies, Vienna, Austria Herta M. Rack, Federal Ministry of Health and Women, Vienna, Austria With the collaboration of Gerald Röhrling, Institute for Advanced Studies, Vienna, Austria Edited by Annette Riesberg, Department of Health Care Management, Technical University Berlin, Germany Austria: Health System Review 2006 The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Greece, Norway, Slovenia, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the Open Society Institute, the World Bank, CRP-Santé Luxembourg, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. Keywords: DELIVERY OF HEALTH CARE EVALUATION STUDIES FINANCING, HEALTH HEALTH CARE REFORM HEALTH SYSTEM PLANS – organization and administration AUSTRIA © World Health Organization 2006, on behalf of the European Observatory on Health Systems and Policies All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. Please address requests about this to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the WHO/Europe web site at http://www.euro.who.int/PubRequest The views expressed by authors or editors do not necessarily represent the decisions or the stated policies of the European Observatory on Health Systems and Policies or any of its partners. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies or any of its partners concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the European Observatory on Health Systems and Policies in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The European Observatory on Health Systems and Policies does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Printed and bound in the United Kingdom by TJ International, Padstow, Cornwall. Suggested citation: Hofmarcher M M, Rack H-M. Austria: Health system review. Health Systems in Transition, 2006; 8(3):1–247. ISSN 1817-6127 Vol. 8 No. 3 Health systems in transition Austria Contents Preface ............................................................................................................ v Acknowledgements ...................................................................................... vii List of tables and figures ............................................................................... ix List of tables ....................................................................................... ix List of figures ...................................................................................... xi List of abbreviations and glossary .............................................................. xiii Executive summary .................................................................................... xvii 1. Introduction and historical background ..................................................... 1 1.1 Introductory overview .................................................................... 1 1.2 Historical background .................................................................. 12 2. Organizational structure and management ............................................... 31 2.1 Organizational structure of the health care system ...................... 32 2.2 Planning, regulation and management ......................................... 48 2.3 Decentralization of the health care system .................................. 64 3. Health care financing and expenditure ..................................................... 71 3.1 Main system of finance and coverage .......................................... 73 3.2 Health care benefits and rationing ............................................... 81 3.3 Complementary sources of finance .............................................. 87 3.4 Health care expenditure ............................................................... 97 4. Health care delivery system ................................................................... 107 4.1 Public health services ................................................................ 107 4.2 Prevention and health promotion ............................................... 111 4.3 Outpatient health care ................................................................ 118 4.4 Inpatient health care ................................................................... 126 4.5 Outpatient and inpatient long-term care .................................... 136 4.6 The integration of service provision .......................................... 143 4.7 Human resources and training ................................................... 145 4.8 Pharmaceuticals ......................................................................... 158 4.9 Health technology assessment and eHealth ............................... 164 iii Health systems in transition Austria 5. Financial resource allocation ................................................................. 171 5.1 Third-party budget-setting and the allocation of resources ....... 171 5.2 Payment of hospitals .................................................................. 177 5.3 Payment of physicians ............................................................... 186 6. Health care reforms ................................................................................ 195 6.1 Aims and objectives ................................................................... 197 6.2 Content of health reforms .......................................................... 203 7. Conclusions ............................................................................................ 215 8. Health care legislation ............................................................................ 225 8.1 Ongoing amendments 1978–2005 ............................................. 225 8.2 Laws and amendments, 1978–2005 ........................................... 226 9. Appendices ............................................................................................. 233 9.1 References ................................................................................. 233 9.2 HiT methodology and production process ................................. 245 iv Health systems in transition Austria Preface he Health Systems in Transition (HiT) profiles are country-based reports that provide an analytical description of a health system and of reform Tinitiatives in progress or under development. The HiTs are a key element of the work of the European Observatory on Health Systems and Policies. HiTs seek to provide relevant comparative information to support policy-makers and analysts in the development of health systems in Europe. The HiT profiles are building blocks that can be used: • to learn in detail about different approaches to the organization, financing and delivery of health services; • to describe the process, content and implementation of health reform programmes; to highlight challenges and areas that require more in-depth analysis; and • to provide a tool for the dissemination of information on health systems and the exchange of experiences of reform strategies between policy-makers and analysts in different countries. The HiT profiles are produced by country experts in collaboration with the Observatory’s research directors and staff. In order to facilitate comparisons between countries, the profiles are based on a template, which is revised periodically. The template provides the detailed guidelines and specific questions, definitions and examples needed to compile a HiT. This guidance is intended to be flexible to allow authors to take account of their national context. Compiling the HiT profiles poses a number of methodological problems. In many countries, there is relatively little information available on the health system and the impact of reforms. Due to the lack of a uniform data sources, quantitative data on health services are based on a number of different Sources, v Health systems in transition Austria including the Health for All database, Organisation for Economic Co-operation and Development (OECD) Health Data and data from the World Bank. Data collection methods and definitions sometimes
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